HomeMy WebLinkAbout2145~o~ii 4 1'72
- Declorotion of Domicile and Citizenship sT. t.uc~E covN ~ r, FLA.
TO THE STATE AND COUNTY TA% ASS888OR.
at . Lwo i• ~ apuN~rY, FlroRmA:
Thin is my declaration o~i Domicile and Citizenship in the State of P7orida that I am ~ this day in
accordance, and in coniormit3- with Chspter 222, Section 222.1?, Florida Statutce.
I was toemerly a legal resident of t~~*~~{ t ~,~ --.___- -, - i~vuo]¢-.--..._
ccxa~
and I resided at______-_-_-.----=---C~ll~ga--Pa~G--~~- -------------------- however, I have changed my domicile
- (S~swt sad No~~z) -._-
to and am and have been a boas sde resident of the State of Florida since---__-_-- d_---•------------------------may ~
_-~,j11n• .~___-, 180.-, and I reside at~ p~ ~- -~iih..-iL=ee_t----------- ---
(BMat and Nnmbar)
Fort Piero • - _ 8t . Luc i s ` ~_County, Florida,
~~ -
and this statement is to be taken as my declaratton of dtisenship, aetwl legal residence snd domicile in
the state of Florida.
((Insac bars and padinat tads. saeL as sale a~ _yso °s of yo...: e.i~°ni~Lmane of ...pbsmat at
tors+ar domkils. ramo.al od tasrib to new
/-pplyi g for hoisat•ad
FlLEO AND ~OROED
' BOOK
IN
1961 f E$ 17 AM 10: 17
ROGER POITRAS. CLERK
S1. IUCIE CC:-'~TY. Fl0Ri0A~
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I FURTHER CERTIFY that I will mister st mai local address when the registration books reopen,
and comply with s1I other requirements oaf a iegai resident of this State.
I FURTHER CERTIFY that I bavs no intee-tion b return to mIr tarmelr domicile. and I intend to remain
--»--~-?~"~:•~- _ -- --(i0tlnty, Florida,
pfa~e)
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Sera~n to sad sub~d b~taer ms tlaia.,l'L.dq et ~~ ~~~ .T ~ ,~~.
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