HomeMy WebLinkAbout0166~~~ ~ 1 218
Declaration of ~cSn~i~i~eMan~~Citizenship
TO THE STATIEV AND COUNTY TAZ ASS1~3t30R,
sr. Lvcn oovl~rY, r~oxms:
This is my decLration of Domicile and Citiseaship 3a the State of Florida that I am tflin2 this day is
soaudaace, and in conformity with Chapter 222, Section 222.17, Florida Statntea.
I was foemerly a 1e2s1 resident of ___ ~-TZAB~ _..__-.---- _-. -~------
sad I resided at__-___--~ L!___________-__--____--____.__--___---------------------. However, I have chatted my domicik
(Strsst cad Nua+bsr)
to and am sad have been a bona floe resident of the State of F9orlda since_-_-_-- -. --EI6~h---- -------------day of
• '~~ _, 1860 , sad I reside at_--- EOd ~.S$Zh fit.
-- (Street and Number)
Sfil Y s 16j'vo v~ • i.~`ti-31o ._Ci011II.+7i I~'lOrlda,
(Ctt~~
and this atatetnent is to be taken as my decLratlon of dtisenship, actual legal resideaae and domicile is
the State of Florida.
((Lnsart here an7 pertinent facts. suet as sale n~ yert or buainsas. os rsliuquisFaent a~ emplo~mea! st
loraser doaieile. nmo~al oot lamil~ to new doamie~s. passe ad Zags. eke.)
~a ~ ~~
Gii cn~L~hYriX~+t1~n J
1 IL. iU I1L1~U11
!! ~~~K
!°.~; .-)fit- -~ Ai' 9:57
Si. LUCIE COUNTY, FIUr,;.,A Ss~
I FURTHER CERTIFY that I will re2iatear at my local address whey the t+eifistration hooka reopen.
and comp>3- with all other requit+e:rleata of a ~ resident of this State.
I rr'URTHER CERTIFY that I have ao intention to return to nq- loaner domicile. and I intend to remain
~ Fgr~ Fia~ i~ +zf . Li~iei~ ~ r~orida
(ab) ~t7.
~iishiagton O. 1~i~~T~_
__ s~~=,
:, ,~
• `~,~
SwOtA t0 sad
. ~- I`• C 1 -~~
N r •' ~:
' ': ~-~
•~~~.
(~ b..~.wi~~' .:
sa.a saps a.. t~.at ats. se..
~..,
~~~ (A/drsM)
~. ~ ~ ~ ..
~ ~~~
f1M wt~ Gwtis•Ae~etlt ~~ aM dtgi;atle wlilt Tait Aaerssr)
~. ;. _ .