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Declaration of Domicile and Citizenship sr, ~uclE couNTr, F~~.
TO TAE STATI~s AND COUNTY TAY ASSF880R,
_ sue' - ia~I=_COUNTY. FLORIDA:
T'hia is my declaration of Domicile and Citlzenahip in the State of Florida that I am ~ this dsy in
accordance. and in conformity with Chapter 222, Section 222.17, Florida Statutes.
I wsa formerly a legal resident of_-______-El._Psao--------------------------____, --~_..._Tezaa_..___-----
(Cib) (8tate)
and I resided at_-_-- -:%i4___~`iioic---....---•--..._._._____.- -.... .- --- - ---. $owever, I have chan~+ed mp domicile
(Street sad Number)
to and am and have been a bona ade resident o! the State of Florida since..- _--_. 2Btllr--._- _- -______.-day of
- --------------~s$t-.------------------------• 19$Q--~ and I reside at-----~4~~illa ~4lLt~-- - -----------
--(Sires! sad RTnmbsr)
-------------------------Ft.Pierae_--- _. 3t.__ I.gois -~______--County, Florida,
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in
the State of Florida. -
(Insert here any pertinent facts. such as sale a~ yropart7 or bnainssa. or relingnishmeat es employment at
former domicile, removal of lamily to new domicue, pnrehase o~ home. etc,)
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FILEC~ IIND RECDRDED
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'~ ~ ~ ~ LR POITRAS, r~r~±;
;.. ~ 11CiFf_.f11f~aTY, FI ~ ~~\~
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I FURTHER CERTIFY that I will register at my local address when the registration hooka reopen,
and comely with all other requirements of a legal resident of this State.
'r r ~~~n,. CERTIFY that I have no intention to return to my fora:cr domicile, and I irterd to rengi»
~•
• - ~ ~_~g _County, Florida,
uL4 ~• J 3~'b. Pf..ezo e•r------------------ 3 L e
- -.,r----------------•--- -------------------------, ----------- -- ---------------------
,~ _201__Hid.,la--~C~.F#..P~e-ro.s-,-~'iar~aas------
(wadr...)
Sworn to and subscribed before me thia___2$firhday of
RGGER~Q I TR~ , C LEEiK C IRCIIIT C OQRT
(To be a:ecnted in dnpliab and original filed with Clem Cirenit Conn, and dnplieate with Tas Assessor)
geen Bao~b Co.. Plant Cllr. Pla.
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