HomeMy WebLinkAbout0169~~~ ~ - .
t. ~u~ coust r. ~w.
- - De~lorotion of ~n~cile and ~itisen=hip
TO Tli& BTATR AND f7~UN'1'Y TAY A8f3~88QR,
sr.i.~ais oovNT~r, rsol~mA:
This is my declaration of Dodnkile and ati:e~ship in the State o! 1~oelda that I am rains thin ay in
accordance, and in conlarmity with Chapter 228, $eotlon 222.17, Florida statutes.
I was formerly a kcal resident o! 2onlcar~ ~ _lrow Tory __~____
(CeY) (~)
snd i resided at-__-13b6__NePg~R=~~8141t~------~ ~-------------- -------. Hcweees, I bare ~hsknsed my domicile
to and am and have been a bona llde resident o! the State. o! Florida since----------~9-____._---_---.-____._day o!
_-- Ooto~~c -______ __-__, 18 ~, and I reside at..___.~St~_~~ 4ytb $~.___:_~~----._._...__.
- ~ (8traat sad Naaitbar)
_~'ort pierce s __$~~i• - _________~___.___County, Florida,
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and this statement is to be taken as my- declaratlan of dtisenahip, actual legal residence and domicile in
the State o! Florida.
((Inaart bare uT partiwnt facts. aneb as sak ~ p_.c os b~uaiaeaa. or roW-gnLhmwt of a®plo~maat of
tormar domici>.. ramoral od fami4 to new doaie~o. pow a~ haoN. a1e.) -
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FILE "`ID RECD~D
S 11~~/I_i~ ir~ n n w
I FURTHER CERTIFY that I will register at my local address when the resiatration hooka reopen.
and comply with aU other requirements of a legal resident o! this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to rennaiu
---------- ------Cotu-ty, Florida,
m------------ n~t_ Pierce __-_--_------____---._-. 8~. ai.l1--
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permanently. .
~~1--. ------ --- ---------------
Tho~maa Boieoa
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Sworn to and aubecrili~
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l+~: ~.;~=- ~-----day o!
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~..~7 ~'= D. 194].___.
r~arr ascssa ~~ea~ s~; i.ars~ -
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Illy Commission eapite~.~ : -' ` .r
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(To M esaeot~ is naDlksb and orisiaal Alad with Clark Circuit Court.'ssd daD2kata with Ta: Assaaor)
Bowen BupDl>. Ce., Phut Clq,- Tla.
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