HomeMy WebLinkAbout12478a9~ 2 66~
Declorotion of t~Edlu~iw~~iCitisenship
TO THE STATE AND OOUNTY TAY A88SS8O8.
..
8t Luc i s COUNTY. FLORIDA
This is my declaration of Domicile and Citizenship in the State of Florida that I am !!ling this day in
accordance, and in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legs! resident of---Ch14.6EQ_-_---------~-_--_._--_-_-_----. _~-111 i net e---_-------
`'_ " "'- -•--' - -` - "---` ' * - However, 1 nave changed my domicile
and I resided at_- - -~J.~-----~'~!orsy~ai~_~-~[-s,~~ur_~.n-:~~---
(Strut and NnmDer)
to and am and have been a bona Sde resident of the State of Florida aince_-._.---1-_..__-___-__ _._-_-___._day of
----------?~e-----------------------------. 19------8,pand I,reaide at-------------.~ ------308 .8.E3..i~bsth-
(Street and Nnasbar)
Fort Pie r o e----------------------. -------- St-.-~~ 4_-- _---------- ----County, Florida,
-------------------------------- (Gtit'l
and this statement is to be taken as my declaration of~ citizenship, actual legal residence and domicile in
the State of Florida. -
(Insert bare star pertinent facts. anch as sale of property or ~o~r;linpuiahment of employm~at at
former domicile. amoral of famil7 to yew domiefle. pnrehase
Avplying for homestead
9189
FIlEO AND REC RDEO
IN _ - . - - _ 900K
1961 ,111.N 27 PM 4: ~3
-?OGER POITRAS, CLr~y ,,, ,~
i. iucit CUUt11T, Fl~i, ,i ~~,~"'
• . .. Il..
I FURTHER CERTIFY that I will register at my local address when the registration books reopen,
and comely with all other requirements of a legal resident of this State. -
I FURTHER CERTIFY that I have no intention to return to niq former domicile, and I intend to remain
~--------------Fort -----Pill'~s----------------------------- -----------, ----------- `~t.---~cia----------------------County. Florins,
(fits) r '
permanently.
-r (Name)
` ------ti]iltrlea --- -----------------------------------
(waar..)
Sworn to and subscribed before me thia_-___ 27.-day of
-_- _ __RQger__PQitrea1Clark
t••
' • -' ~ , I~,, w
nitCour~ ~~; i ~.,n~.:.s. As
(To be executed in dnpliab sad orifinal Bled with Clerk Clmiit Conn. sad ddtilieaLe,•w~ Tas Aaeseor)
Rnrs-n BUDDI• Co.. Plant CYtr. Fla.