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ST, l~ COINI Y
Decloroti4n of Domicile an~ ~i~izenship
TO TH$ STATE AND COUNTY TAJC A88S980R,
9'!'. LIICIE COi3P1'1'Ya FLORIDA:
This is my declaratioa of Domicile snd ati~nahip in the State of Florida that I am ~s this day iA
sooordance, and in conformity with Chapter ~, Sectioa ~.i7, Florida 8tatutee.
I wag formerly a legal resident of _ ~~---Sa.alGali • -~•=•---i~I _.-----
-__ _.__ , however, i have cirlaa~ed my domicile
and Iresided at._.._~~--~2!!AlQOa iLAatls_...____.___..-__-•-
f,,, c st>".s gad xam~e.~~ 11
w ~V iJL w$d ~~~i 4ib:.>v .~. ~~ A~i` M~~~aw~ n* tf4P Q*~t~ At ~5=~ It;T4i~P ._.. _ A _ ~!V A~
----------- onguat----__._____-_, 18 ~ _snd I reside at_____~~4 8~._.g.?~_~~~_---------------__..
tsa..c .>oa xtta~;
---- tort P_ieroe Bt~I,uoie ~M~_--____-__.County, P'iorida,
. (Cib)
and this statement is to be taken sa my decLratiasi of citirs><iahip, actual legal resideACe and domicile in
the State of Florida.
for ~ ~ toto ne+.~domir~N. ~nx~a a~ lion ~e~nLLm~nt o~ ~malosm~at .t
App>4ing for homestead
91232
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I FURTHER CERTIFY that I will register at my local address when the re~ietration books reopen,
and t:ompl;; with all other t~ui.~m.~n;.s ^f s isgal reaideut c-i thle Stelte.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain
in__-________.1r4st_~il~~_____________-___-- - ------$t.--I+~ai~---- _-_County, Florida,
(cite)
permanently. ~i!2'~ .
(Name)
Erin 8torme
_---------------
- _
t~~L.
.Sworn t0 and subecnbed befcn~e me thl/__d_______day ~ r' .)4, .. ,~~ ..~1'h~
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Boer P4itrea,C3.sr~o~ Ci~o~it Coact ` j,.. .
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. ... (To M .zixobd iii daPSkab end a:itiaal >bbd with ca.><t (~reait Codrt, gad dt~Pikate with Tax Aaaaaor)
Boras faPPly .:~.. FW-t pty, Ila.
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