HomeMy WebLinkAbout0236- ~~~ 1 291 -.
' ST, ~UCiF C01l~IT~, Ff.A. - .. .
Declorohon of Dometile -and C~~:enship
To Tai S~rAT$ AriD CourrrY ~nz asi~seo>~,
ST.IAGIZ OOUNTl. FLO~BID~:
This fa ay+ declaration ~~ Dami~ile sad Citl:.aahip in the State of Florida that I am >~ this day in
accordance, and in ooniormity with Chapter 222, Section 222.17, Florida Statntas.
I was formerly a legal resident of ~ --_.A~hL.a~l_. _ ____~, _ =~ittao .
tale) te~sa?
+~; b r-ee5~:a3 ::t_---'~~~_~~_'_--~'~ ~wn~ --__.----____---- - - - -------. :icwa~ar, I ~~e ~~ my do~t~::e
(Street sad Nosber) -- - - --
to and am and have been a bona lids resident of the State o! Florida since.-----.nth--------------------------day of
-- - ~T -- -----------------_. 19_4 . and I reside at S17 l[. ~ Si . __ -------------------
(SMet sad Nnmber)
___---Fort Pi fro • Bt . Lno i • - ~_C.ouab-, Florida,
(fib)
and this statement is to be taken as my decLntion-of dtise®ship, actual legal residence and domidle in
the State of Florida.
(Insert here atr)r pertiwnt taco, each as sale_ _ yro ~ der etet~li>~oleLwat at esylo~awst at
former domicile. removal of tamib to nev domicile.
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S,. IUCIE COUN11f, FL'u;,•~a
I FURTHER CERTIFY that I will register at my local address when the registration hooka reopen,
and comply v~ith all other re~uirsments of a Legal resident nt t t gtate.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain
Dort Piero • ~ ~ e
m-------- -------------------------------------, ------------ _Coun .Florida,
----------------- (Cit7)
permanently.
E`~erette A. Hell anil ~-----------__
Sworn to and su •b4lp~(e,tpe this_-• 6__-day of
(Addrwe)
~ ~~- 1?ttLljc ~osw at T.-rs.
My Commiaaion• ~,~pti~es:.- `~ i~>rl/8;3
.... ,
(To be esecutal`iti•dttnikster;and original Sled with Clerk Cirenit Court. sad daptkate with Tai Assessor)
Bowen anDD17 CO.. Plant Citr, lla.