HomeMy WebLinkAbout15948~~ 3 3~.3
ST.4UCI COUNT F ..
Declorotion of Dom~c~~e an~ ~ihsenship
TO THB STATE AND OOUN1'Y TAg ASSS8S0>l<,
a. ~ nt?...n~ et QOUNTY, FLOBIDA:
7~is L m7r deeLration od Demicile and Cxthesrhip in the SLte of Florida that I am Slim this day in
acxordan~. and in conformity with Chapter 222, Section 282.17, Florida Statutes.
I was formerly a lagsl resident of ___._~ Thome~~rill~__ --------. ---- ice) ----------
(CiV)
and I resided at____-_.._X14__1~ern__S~sl~e-.-_.--~w_--------•----------.---. Iioweves, I have changed mY domicile
(Street sad Number)
tr,; :..,rte • s i,_,~o ~o .;~,~P~~ :.t t~,~ ~ty~ a! I~a~ e~ce-------1st- - - - ----------day of
Lo auiu uiu ouu .ate... ~.~~•- _~_____ __ __ _
_1~4>~raur~------------------__, i~l_, and I reside at-----1805~Ha~anne ~~e_i_-_---------------------
(se::.i aba rie~)
------~QFt-- p1 ego s - _----- $t .I.na i e _- ~_Connty, Florida,
_,
(Cib)
and this statement is to be taken as my declaration of citisenahip, actual legal residence snd domicile in
the State of Florida.
(Insert bare an7 pertinent taets, such as safe et pert~r os business. or inlinquishmeat as employment at
torsser dossieile. removal of tamib to new tlomidle. pt~aee of home. Ne.)
$ntering Archie reed Dyer Jr in 4th grndeo! school
921u:~
FILEC AND RECORDED
IN ~ BOOK
1961 FEB -6 Ail 9~ 33
S..
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;~ fit. rr'' ~,,,, ,. Gp •; ~.
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen,
and comply with all other requireraeni.a of a legal resident o± this state.
I FURTHER CERTIFY that I have no intention to return to my former domiciie, siiti i iiltcT,u `.,a rsa;.si.^
i~___ Fort _ Pi era e
permanently.
(c~ti)
Sworn to and subscribed before me this-----___g--day of
February------------------• A. D. 19 81
----- !''~~IGCti -----------
-- -Notary Pnblie State ad Floslda at Larp
Jan 151964
My Commission ezpirea_-_-_------_~_
St . LuC ie ______________-__County, Florida,
(N ) ----- -- -- ----
Mrs.Opal ]a~yera
___.__-- - -_-___-_` (Address)
(To be eaeeuted in dupliate aed oritinal >31ed with Qerll Ciitid~~Uaw1A~~d~d~
an..a~ Buoo11 Le.. Plant Ctb, PIS.
with Taz Assessor)
_;`
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