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Declaration of DoTmi~e ont~'--~ifizeoship
TO THE STATE AND COUNTY TAY ASSS$808,
Q - e T_ ~" i. Covrrry, >~,o8ma:
1 s-
1 eis is -my declarstion of Lomiciie sad Gitisenship in the State of Florida that I am i3ling this day in
accordance, end in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of_________P`reeport~__L.__I'__-- -- I~T~~ YQ~--_--------------
and I resided at---- __-f~__~b~i~-7~---__«_--------------- ------- ------- gowever, I have changed my domicile
(Street sad Number) - .
tr, an.l nTn and hAVP been a hone apSde~~//~~t+eaident of tha Stx#.- ~f Ft.+ri.te e.....e R ____-___ ~'ay of
` ________________ 1J___i;~Ut, l~~ I rwci3o pY_-«~~~-~~~- ~_
- ------------__v'siaic~------------ ~ -to~~~.
r-- ~------------------
(Street and Number)
I''(yr't Pierce ------------- 3t. Lucie_-__«-__-._«____--_--__County, Florida,
-------------------------------------- --
_ (city)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in
the State of Florida.
(Luert here any pertinent facts. such as sale of yroperty or business. or relinquiahmeat ad empioymeat at
termer domicils remo~sl of family to new domicils. pure • o! home. ete.)
Applying for homestead
91531
F~~ED ,AND RECDRDED, .
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Inc ~•. ~' r1..1~ ~~,
;~~SGER POITRAS,CI~"f
-. L'JC1~ COUNTY, F: ~' -•~
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I FURTHER CERTIFY that I will register st my local address when the registration books reopen.
n.i ns~nl•r mit•{~ X11 n~1•o• ror•..irorr~on~o of a lortq~ rstoirlpv~t• of •1•ie C6..~n
I FURTHER CERTIFY that I have no intention to return to may former domicile, and I intend to remain
• e
Fort P erc ________$t, ntlcl~______________________County, Florida,
(city) _ _
permanently.
-~~- - ----- ------- ---- -- ---- -~v ------
(A1 )
____William__J,1rAulkner
Sworn to and subscribed before me thia___l,?_ __._day of ~~J` •••;_`~_ :-.
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----- Ja-sue ~~-----------------------------------. A. n. ls__~. _: ti :• ~- .~. t~
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/ BogerPoitrea,~lerk ofCircuitCourt ~~~ t•~i,rJ •~- -
(To be executed in duplicate and original filed with Clerk Circuit Court, sad duplicate with Tu Assessor)
Hnvon riuonly ('o.. Plant Cit), Fh.
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