HomeMy WebLinkAbout0610~~~~ 2 1-
• ?. l;1CiE QUMI`t+ FLA.
Declaration of ~mici~ and Citizenship
To THE srw'rE wxD covrrrY T,A,7C Ass$seox.
st. Luse oovrrt~r. FLO>~s:
This is my decLration of Domicil sled Ciifseioship in the Stag of Florida thst ~ am filing this ~Y in
acc~rdanoe, and in conformity with Quptr:r 2$2, section 282.17. Florida Sbtutee.
I was formerly a legal resident of.~_s?®ail9~.IDle -..- --------- --. ----~~------____
(olb) (Stag)
_ - _ ~ P : n _ P ~- ~ 5 Haesever. I have ehanged my domicile
Yi14 ~ iWi..L.. v.r._--.. _..-..-.__-.__-. .._...
'~Straet sad Number) -. - -
to and am and have been a bu;,u ~3e I3~a@SYit of :~ c SwLc of I~!o:ia..a sf~_..__---.- --~---- --. day of
-----•----Ja-gig--------------.__. 18----8,land I reside at_-~_-_~ ~Q~~_~~---________-----------------
(8tms sad N~ber)
Dort Pierce 3t. Lucie County, Florida,
(Cib) `
and this statement is to be taken as my declaration of dtiseiaship, actual legal residence and domicile in
the State of Florida.
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(Insert bare any pertinent tacta. such as sa4 of PearCbeN o~ 5omt.or~t~lia9nLhment a~ emtplormeat at
forme: domicile, remorai of (amity to new domicfle. D
Haver: been o~erseea with the Department o! Detenae for the lent
14 years.
914'73
f ILEL~ AND RECORDED
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inc.' !r1?. I ~ 0! 9: ~4
IJb• vr.. ••
- - i;'.-i,ER POITRAS, CL["`;
S ~. LUCIE COUNTY, FLGn . h
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T FT?u'i'HFg ('ERTII'`7~ that I will register at my local addrPsa when the registration hooka reopen,
...a.. ..* Ine.et rn~~AOTt (1T LOlls ~{~a1.C.
and comply wii.ia ail vi.i.ei ~~_~ ~~••~.. ~_ K .-emu- °_-°-_
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain
St . Lu01 e ~ _ _County, Florida,
~-----------Fort__PierEe_-------------- - --------------------------
(Cit7) -
permanently. ------~~~~ ~~~,~.••-- ~~-~---------------------
---- (Name)
Sworn to and subscribed before me this__~.Q.-_..day of
-- d entiar?-------____-- . A. D. 18.__ 61
-------_~gnr-
My
Court
~C ~ • ~
.,- .. .YS.~.
(To be executed in dnpliab and orisinal clod with Qerl[ Gait Comt, and duDikate with Tas Assessor)
H.,..a., $uonl• c'o.. pl.nt Ctti. Fly.