HomeMy WebLinkAbout1576. - -
' of Daaicile and ' ' -
peclaroh~n .
. - si. ~tIC1E COUMtr~ ~~A.
TO TH$ l3TATS AND C10UNTY TAZ A88~480~B. ,
8~ . • Lis ie mUl1iT!-~ ILO~ID~:
This L mqr deehratbn o! Danioitie aed ~ is the 8tst+s o! l~orida that 1 sm ll~t this daI- in
socordanee, and is ooofamiq with Cbapt~r P.St. 8eeti~l Sii9.17, P~orida Statutes. ,
ws.: _*:~'*~'-"'~~ • laal i+asident ~ -- - ~ i I _...__.__
- tom)
and I resided at_-_-----------Bow-S.bL .----.--- ----• However. I have 8bang+ad nil' d1e
: rsd rt~>I.~)
to and :~ sad ~:e ~a ~ i"=~ ~' re~i~it Qi the State of P'forlda sinoe.____-__-1Z--------------------_~~' of
____-- ~~_ -- I9.~, snd I reside a6 ~„ id x,~) a 1tF
?or3 ~ arse ~ __SZ. •• I~~ ~ --Connh-, ~~~
____ tCib)
and this statement is to bs takAn u my declaration of dtisenahip, satual legal reddence sad domicile in
the State of Florid:.
((In>~t lire W p~rtiaal! taela. a>oei v a~i~ o[ _}ro~pu~7 or etb~..°ii~0e~ d ~piopawat ~t
former do®ki3e, raao~d ~ ladb to arw do~Nw. oseLw
•pp].~iDg for hoaeatead
. •-~ ..; -
IN
~'~ eo
~~~ f ILED ANO RE OROED
OOK
IN
QOOK _
18 1961 FEB -4 AM 10: 18
anRFR P[11TRA5_ CtERK
.-•,N- ~•
1 vV
... - .. 'rr.-. -
tDr~i~~. ~ •~tf . __.:n ~~.:~s~.. ~• sr~e IMa1 ail[irt~sa when the ~jatratlOn books reOpW~
I FURTHER ~iEl;~l~ Z 'Lf1ar, 1 will r6~aswa o~ +•v •••.,--
and comply with all other requirements of a legal resident of his State.
_ ._~__ a.....:..;1. enrl T intend t0 )c'BIDaill
I FURT'HEA CERTIFY that I have no intention to return io ~ avru,ca ~..=..=r---, ----- - ----- -
F rt Pieros ~~~-`_~, St.~oi_ a __ _Connty, Florida,
(caa) -
permsaeatlY• ~ -----------------
----- (Naaw)
Sworn to and subscribed befars me this------4•--day os
- A. D. 19_bl.
~- II~QZ-~yl-
(To be ezaeuted is daylkab sad orisiasl sled will Cfeet ~ OIIel
Hn:lY+• 8UD617 Ca_ Plsot CIt7. ~.
_ ~ J •. •~~•; ~ 1i
••y.
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iiy`wlll'hs Aeeefeer)
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