HomeMy WebLinkAbout1175ST. lUC1E COU#Il
Deciarotion of .Domicile ai
TO 1'HE STATE AND COUNTY TA8 A88E880R,
8t. • Lin a COUNTY. FL08IDA:
This is my decoration of Domicile and Citisenship in the
accordance, and in conformity with Chapter 22Z, Section 222.1
I was formerly a legal resident of_~__~~mphsllip~I,
and 1 resided a>~----- -- ---~~_iYi--------------------------------•-- --- ----
(8trast sad Numbs) _
to and am and have been a bona fide resident o! the State of
----------------~~---------------------------~ 1~----~ and I reside at------~
---.~.~.~~~---------------____-..---------------~.t
and this statement is to be taken as my declaration of citizet
the State of Florida.
(Insert bars and pertinent fae4. such as sale o~ party or b
tormsr domicils. rsmo~al ad family to nsw domicfls. pnrelws <
I FUt~THER CERTIFY that I will register s*_ ~% !~"'?
:.;~ ~o:::Y~} ~Yith all Qt3ef!r t~Pl~!l!2`$T!2?3!L 4I 8 lasial z~si;cut of
I FUATIiER CERTIFY that I have no intention to retu><
in------------------ ~t-.P1.8rQQ ------------------~ ------
--------- s--------
(Cit7)
PQ ~~
.j'.,.~,?T , . ~ ~
~~~ ` - -
- J
'' ~~~ of
SW0141 tb a~~Lld before me this-_-- bay
..~,
._ ._ -
---==~-~-~- ~ __ ___------------------_ A. D. 191-.
Rp(~, t ! , CLERK CIRCUIT COIIRT
BY . '~ , ~ ~ --D. C ._--
(To bs a:seated in dnDliats and original Alsd With Curt G
n.~N-.. •. HunD!• (-O.. Plsr.t Cttl. Rla.