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Declaration of Domicile -and- Citizenship
TO TI3E STATL AND COUNTY TA7C ASSSSSOx.
S T LIIC IK OOtJNTY, FIARIDA:
This is my declaration of Domidle and Clt~ensisip'in the State of P'forids that I am Alias this day in
accordance. and is conformity witb Chapter 222, Section 222.17. Florida Statutes.
I was formerly s legal $IAGSPORT _. TENN . ~.______.
resident of____________.._.__~.______.____._____~______~, -_t~j
(Gtr)
sad i resided at___-._(~~n__R~~._...~,---_.___.. ~------------------------• However; I have cl~sased n-Y domidk
cstr~.t ssd xom~) 21 s t
~~ :~ gm sea have been s bc-~ Ade reeidert of the Stats of Florida since------- - ---------- --- - .. dsy of
e m12f3T _ , 19_~S2_, sad I reside at-~`4SL~or----~-ova- - --------- ---
(BtrMt sad Nambr)
FT. PIERC$ ~ ST. I,UCIE ~~~__--_-__--County. Florida.
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and this stateawnt is to be taken as my declantioa of dtisenship, actual legal r+esideace and domicile in
the State of Florida. -
((IaMrt bra w p~rtiasnt tsat+. sncL as sab_ o[ ~opsrt~ os ~ ~ ~ ni~hmeat od a~dos~t st
torawr dask3M. remo~d o~ lsmiu to arw dome. puss
Entering Karen Dalton in the 6th grade
"- - Jewel Dean Dalton
in the 5th Grads
" Betty Dalton
s! a8 t'ilj~ riai taYa
.-
911'7$
in the 3r8 grade
ia. the lnt grade
..,,~,.,,, , FILE AND RECORDED
`''" ~-- ~,' LUClc COJNTt" FLO,.. A/Q71~+(J
~~I!f/n j. .!Il
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I FUIiTHEB CEl1TIFY that I will nsLter at my local addr+as when the resistratiow books reopen.
and comply with all other requirements of a legal resident of this State
I FIJETHER CERTIFY that I have no intenticu tD returA to my former domicile, and I intend to remain
~ FT. PIERCE ~ sT. ZUr;i$ _~,,,~,~ g~a~
(C`4-)
perm~tb•
uv- r :0~'`'-,~K~--- :, JA1~3 L. DALTOS 1 _~.___.
li.~t~C~~a~d'+~ lief^eoes nm ~~ 5th dy ~ .
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to i» b a.Wteate aai ee1~s1 fIN wldi Astk Cfwek CweR ..~ iiySaa wlti Tas As.Meee)
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