HomeMy WebLinkAbout2461o. R. 4 490
Declaration of Domicile and CitizenshipeooK F A.
ST, IUCiE CQUNTY. L
TO THE STATE AND COUNTY TA% ASBE-98OR, `
~. SE. Lao•~ apZJNTY. FLORIDA:
This is my declaration of Domidle and GYtisenship in the State of Florida that I am tiling thin day in
accordance. and in conformity with Chapter 222. Section 228.17, Flori Statutes.
I was formerly a k8a1 resident of - (~) ----• - (eta) -'-.
49 Went Lens _ ~--- -------_----_----_-__-. However. I have changed my domicile
and I resided at_.._________---------- (Street awd Nmnba)
__ day of
to and am and have been a bona lade resident of the State of Florida since---------- --------------------- ------
pobober 191 Cestana Court i Part St. LnaS,s ---
_ ~~__._ 19 ~, and I reside at-~_--- ( ,~ Nombar)~
_ Fart Pisroe,Flarida ~__ St. Luci,~ w____.-- -__County, Florida.
- --.
((xts) ~~
and this statement is to be taken as my declaration of dtisenahip, actual legal residence and domidle is
the State of Florida.
(Inset bay W ~ertiwat facts. weh ss sob of ~ or bnsinw. or rolin9~ma~t a~ ompioymoat at
forma aomfd3s. rsmo~al of famib to ~ doanie~. a~ >,o~e. etc.)
applying !or hoasatsad asld xidow
Fli.ED AN
D~R~CORDED
_
1961 FEB 24 PPS 12:29 -,° ~ ~ -
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ROGER POITRAS
CLERK ~; •~ -'
• =~ ~
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ST. L~~ri{ rGJNTY
F! OKI" ,
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and oompiyall othotherer requirements of a legal aresident o~1 ~~ hen the re8istration books reopen,
I FURTHER CERTIFY that I have no intention to rettnla to my farmer domidle, and I intend to remain
~ Tart Pieacos _ St. Laois County, Florida,
(Gb~) -
pD7• /~Ci) . Q~
tl~iassa)
noi.. rsnarw ~ U
Sworn to and Wbacsibed be3ae~s sfls tbis~.21i.__.._dyr, at .
Felb~'~ ~ A. D.
Roger Poitaraa, G1~s:k a~t oironib oerart
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(Z1s ba awssob~ la ~sN awl aiwssl ~M wMr CMeit Qnsie dwR ~ wttl '11ss AMesmd
ae.•* hosts t1... Pis~t Cks. ~U.