HomeMy WebLinkAbout1957~b~~ 3 689
Declaration of Domicile and CitizenahigT, ~~~ couNTr. FLA.
TO THE STATE ANU COUNTY TAB A$Sliv$t3OR,
sT, Lucia ~~, rzoRms:
This is my dedarat3oa of Domicile and Citise~iship in the state of Flo:iaa that I am Ahng this day in
accordance, and in conformity with Chapter 222, Section 222.17, Florida Statute.
I was foemerly a legal resident of__~__-_. IROfi'!'OA - _ __ _ __~Q-______
(City) - (~~)
and 1 resided at__-_ v_l_. ~~,~-~S?A-_ ~_:__--------------•-----------------------. Iioevever, I ha~•e changed any domicile
(8trest sad Nnmbrr)
to and am sad have been a bona 8de resident of the State of Florida eince_-_.- - _1Sth________ __________day of
-------3ept~etllber ---------, 19_-dQ and I reside at__~?~~_~ -- F'T.~l~i_~ ~~~ ~.~d_----------------
.~ (8teret and Number)
--__-----Fort Piera• _____-, 9t~_ ~~~4_--------_-----------_.County, Florida,
and this -etatetnent is to be taken as my declaratioa~ of dtiseaahip, actual legal residence sad domidle in
the- State o! Florida.
(Insert bar an7 pertinent iatds, loch sa sa4 at _yroyarttr or6~e~z~2i~+9nishmsn! ad amDloTmraat st
former domktir. rrmoral a2 tamiy to nrw d paxbasr
_ 923' 1
F~LEC 1~'<~ °E~C? CEO
7
t;....,,. ~Et' 1 ~,T "' tern`
y ' .~''~
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I FURTHr.R CF,RTII•'1' ti7at I will register at ray loesl address whin the registration tooka reopen,
• • •• • • r 7 ~ 7~_..a t 647.. Ca_a.
anti t:out~7t}+ VYlbi! aft ~itlrr re~tiiniucu,8 vi n acKoa icoaucuov. iriiso vwi.c.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain
. Fort ~i a ra e - 3t . Lua i e - - -- - ---------------_~ty, Florida,
m-----------------------------------------------------------------------• ---------------- - -- -- --
(cit,)
permanently. -
f ------ -----~ -- -----
(Name)
J es D. Blankenship
(Address)
Sworn to and aub~}~ed.~}gioe+s me thia._13___---day of
.-
hebi!u4t~~.. - ~. A. D. l~l_
_-----_- •r_ ~ ~ j~~~~~,,~~
- - riot::,->~>~'~ ;~ in.
My Commiaaio~l ~ - ~' .~t.:~'j2'~6$'
(To be eYreated ~in,dn$lieiti• ind oriRinttl dlyd wkb Ciat Cirettit Court, sad dnplieatr with Tas Aasessos)
Bowes BopDy Cs., Plant Cltr. ~•