HomeMy WebLinkAbout0612o~R~ 2 - 3
Declorotion o~Ttfo~m,c11~TTan ~ itiz Wahl
e ~C e p
TO THE STATE AND COUNTY TAX AgSEggOR,
sr. LvciE covrrrsr, FzoRms:
This is my declaration o! Domicils and Cltisenship in the State of Fk-rida that I am sling Chia day in
accordance, and•;in conformity with Chapter 222, Section 22'1.17, Florida Statutes.
I was formerly a legal resident o!_-___ ~~'~ ____ _____- __--~ -ILI,INOIB
(~) _ - (8t~s)
and I resided at-----$4~8__IrtiD~_,IItiT..a_-----~----.--- ----- -- - However, I have changed my domicle
t L~.w.t .~ x~~,~ s
to and am and have been a bona ode resident of the State of h'1_t+rida a;,+re-- ___ 14th __ __ _ ____ __ a-"~ of
----------?tdiiiat~,iT___________-___--__. 19 ni, and I reside at____~--T47k!!1l-~~t_-----
(Straet and Nnmbarl
~'ar t Pieta s 8t . Lnai~ _ County, Florida,
-- (cit,l
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in
the State of Florida.
(Inaart taro at>y pertiaeat facts, such sa sale ~ put~r or business. or relinquislment of employ>oaeat at
format domicile. ramoral of tamilr to new domfdla. pnreimta at Romp. Ke,)
EnLSri;,~ ~.R. G;,13iiFou ire jiuuli~s ecllool
te~~a~sai~.al~~
1- Dsnuis Cordell Hampton
2- Douglea Cary Hampton
914'75
FILEC ,~~~lD R.ECDRDED
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~~~ ~~,~; I c; ~~,I' 9: SG
~.. ~~ POITkAS. Cl~".1:
;;i. IUCIE COUt~'fY, flOnti~.A~
,.1t:~ilile~„
,~.:..~,~A, '`:a
:,. .
I FURTHER CERTIFY that I will regiai,er at my local address when the registration hooka reopen,
and comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain
• Fort Pi ero a 3t . Luoi a _________County, Florida,
- -------------- ----------------------
(cis,)
permanently.
Name
Carl E. Hampton
_ . •;
Sworn to ands
.~_;
'~' `r~~~ ::
---~--•F
_~` ~.
U ~~
My Commiaisib~
this_-- 16_---day of
A. D. 1961
~ >liioi~"~t Lar~r•
_-_
~PUIT~I~ : -
C1E CCU'~T~i.
s?'
(Address)
(To be ezecf~ed,i}f;~lplit~i and original sled will. Cleric Cireuk Court. sad duplicate will Taz Aatesaor)
Rn~..~ Buooh Co.. Plaut C1tr. pls.