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D lorotion o~ Dort~ici ean~'~itizenshi
ec P
TO TSE STATE AND COUNTY TAX ASSFSSO$,
~r. LvCis oovNTSr, >~t,oRIDa:
This id tqy declaration of Domidls and Citisetuhip in the state of Florida that I stn llling this day is
aooordance, and in coniortuity with Chapter 222, Section 222.17, Florida 3tatutea.
I wsa ioirtnerly a legal resident of. ~~0~_-- ._ -_---------------. _~1Q.-____.__.---____--
(p4) (State)
at:d I resided at__:-__-_--Gen__Del_----------_-_.-...__------------------------ --_---. However, I have cbaa2ed my domicile
( a.u iVOmbesl
to and am and have been a Dona $de resideat of the State of iiaYada si~________~~~~-------- ~_.. „:
---- ----------~~ Y-
~~I' __ 19 40 and I reside at____10E1 Besoh Crt -
(Street anei Number)
~'T. p~~is S'r. LIIC~i !`nnnty. Flnridn-
(Cib)
and this statement is to be taken as my declaration of citisanahip. actual legal residetioe and domicile in
the State of Florida.
(Insert bare aqy psrtineat faeL. sucL as sa4 0~ part or bnsiaeee. or relinpniebmea~t of eatploymeet at
former domicile. remonl of famitf to new domle9e. a~ hove. ete.)
cam.. .1 {.~
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~Itfp Ai~O R~COROf 0
i - BOOK
196! JAN -7 AM I I: 35
Ri;GER POiTRAS. Cl~"K
ST. IUCIE COUNTY. FlOi-+UA
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i~ ;~.. viy;~yit~tEk -.:.:.. -
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.T....y~.`_,~,.
I FURTI3ER CERTIFY that I will register at tqI- kcal address when the registration books reopen.
and comply with all other requirements of a legal :+ssident of this State. -
I FF~ TRTI~$ CERTIFY tlt:t I have tso intention tD return to mlI former domicile. and I intend to remain
-Count7, .
(Ab)
permanantb-.
s '
`'jr,~' ' before ms t>sis_..1xh..d~y o!
:~:
ir. ee ~a.vo.+ la d~fea..w «ydsal stM .ltt ask pewK C.~et .M dartie.a .des ~ awe)
Mr+e e+vNr G. lfett ~. Rir.
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