HomeMy WebLinkAbout1735~oo~ 3
~ UCIE.C
DeclQration o ~omici~
TO THE STATE AND COUNTY TAS -ASSE$9O1~,
sr. ~ua~s cotrl~rrY, ~ol~s:
This is my declaration of Domicile and Cltiseaship i
accordance. and in conformity with Chapter 222, S„ectioi
I was formerly a legal resident of__~QL~__~l43C~.
and I resided at---- - - --------- -- ----------------------------- --
(Ste~eeR sad Nnmbes)
to and am and have been a bona fide resident of the St
---------------N(reinber________________ 19.60_ and I reside at
Dort Pierce
-----------------------------
(Cit7)
and this statement is to be taken as my declaration of
the State of Florida.
(Insert bare tarry pertinent facts. such as sale as~yroger
former domicile. removal of family to new domitdls. ptu'
92i~2
FILEC A~!D RECORDE
°6i r~t~ -a A~1 ~Q: 5
ROGER POITRiq S [lam
S`r W GE ZA t,Ndiy F'te ~P~aA
I FURTHER CERTIFY that I will register at m!
a-,u c:,.;.;,1~ ~:t:: s11 other requirements of a legal reside
I FURTHER CERTIFY that I have no intention to
(ctt,)
permanently.
Sworn to and subscribed before me.ihin; ~.._®---day of
.,,~ • .
.• •.
February '.~ •'~ ~' ';•A.•~D,'7~9 61.
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My Commission ezpirea_~. ~~'~~~~~, •' ;.~. -
(To be executed in ttop~eate and nriainal tiled with G7
Huw'en Buppl~ Co, Plant City, FIB.
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