HomeMy WebLinkAbout1186~b~~ 2 ~ 5~5 , _
Declarotion 'o~TDomici~eT an~ Citizenship
TO THE STATE AND COUNTY TA% A53E.93OIi.
as. 7IIC~E oovrl~r, Fr~oRme:
This is my decLration of Domicile and Cltlsenship in the State of Piorids that I sm lllin~ thin day in
accordance, and in conformity with Chapter 222, Section 222.17, Florida Statntea.
I was formerly a legal resident of_~__~~~''TC bbl __i_ D•_-~-'__-i ---.------(~) `--------
--- .._ aowover i Hard w i......~.»-..
and 1 resided at-- - %:z~--i--~-lta~ot~--~1~aa~-r--~i a TT ~ ' ' - --- ~++~~ - , ~ ~' `~,i"~~'~
--- (SttMR sad Nnmb~z) ~ ~----
to and am and have been a bona &ie resident o! the State of Florida since-_-___- $~- .--_._-.__._---____-___day of
------------Deae~Dsr------------------• 19_dp, and I reside at.__~.~Q__~lAxDaL_S~ssst~and ~) ~,L_Ln4i~--
-----~'°rt__Pierae---- --------. ----__----------8t~ Luoie----------~~~'~ Florida,
(cit,i ------
and this statement is to be taken as my declaration o! citizenship, actual legal seddenoe and domicile in
the State of Florida.
(Ituert Mrs aa7 WrCinont taeb, web as~aia a[ yro~rchasa os Isomo.or~r~lin9uishmont of omployn~t at
former domieilo. romo~al obt lamii~ to now domidle. Dn
A~nlvin~t for homestead
g ~~8
FILED AND EC RDED
' _OpOK
IN . _..
196 ~„tt 26 PI<' 2: 3~
I;JGE E COUNRY FIUFE~~ A
ST. LUCI
,,.. -
~~r•.~,..~r~
I FURTHER CERTIFY that 1 will register at my iocai addF~e w„eia t: a :'€sio`~ ti3'~ ~~ reopen,
~.
a co:r,^~~ mi±): all nthnr rannirPmPnt.~t of a ie¢ai resideni of tini8 arsix.
.. •Y•~ - _ --- ---- - -- -
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain
~--------Fort---Pierae_ -- --------- ---------, ------------- St-~-I'-~°--~4 ----------------------County, Florida,
- -- - - ------------------------ --
(Cit7) ,
permanently. ,,'/ ~ - -- --- - --------____--
------_C1' - - - - ---- - --
(Nam~)
Sworn to and subscribed before me thia_____2B.__day of
--_ _ __Januer-y----------------------------__, A. D. 19__----¢l
... ...
.11f11.liara- ~B._.Sirl+ii---------------------------------
_.` `i ~ s~ .,.
`~..• ~~1~i: v
,~ .-
Roger Poitrae,Clerk ofCirauit -Court ~ ~ ~ ~ ~`` c,~ ?~
(To be executed in dnyliatt and original Sled with Aerk Cirwit Conn. sad doalk+t• with Tas Auaeor)
u:..•-~~„ 9ur,nis ('o. Plant Ctrl. Pla.
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