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-, - .-'
DeClarat~h ~~E rJtYJ.\lcn~' and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR.
ST....- UJC):E __ _ __ ,_ COUNTY. FlQRIDA:
This is my declaration of Domidle and Citizenship in ,he Sta'e of Florid. that I .m filing this day in accordance.
and in conformity with Chapter 222. Section 222,17, Florida Statutes,
I was formerly a legal resident of
WARREN
MICH
ICity)
($t.te)
and I resided .t, 23311 ~ap~-
(Street Md Number)
However. I have changed my domicile
-
to and am and have been a bona fide resident of the State of Florida since
24th
day of
JUNE
19 61 nd I 'd 1216 Texas_ Cr,t. -.,
_. _ _ . a resl e at - - -
(5lne1 Md ,Numbet)
For. PIEl\C&
ST.. lllCI.E--- - - -
County. Florida.
-.
ICity)
and this statement is to be taken as my declaration of citizenship, adual legal residence .and domicile in the State
of Florida..
(1......1 her. any pertinent fecta, auch .. ~Ie of property or busInea.. Of r.linqvlahment of employment, .1 tom- domklle.
...novel of family to new doMIdle. purcMM of home, etc.)
~TERING (3) CHILDREN IN PUBLIC SCHOOLS
Karren Lynn Costopoulos 9 yre.
Vicki Lee Costopoulos 7 frS.
~~chae1 Louis Costopoulos 6 Yrs.
!J"OI(8
FILED AND RECORDED
1~~.m("tM #~BOOK
1961 AUG -7 l\H 9: 43
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I FURTHER CERTIFY tha' I will regiater at my local address when the registra'ion books reopen, and comply with
all other requirements of a legal resident of this Sta".
I FURTHER CERTIFY that I have no Intention to retum to my former domicile, and I intend to remain in______
___ _ _ __ __~~..Pi...rCJL--- ------- ----' ---
(OIyt
perma~y. -
____St...._WC1..4L n _ __ ___ ______ _ County, Florida.
. .. "'." '.
,. . ,
-?J:rut~-I&~hJ-.-r ~ ~
, (NMw) -- -~(f -
lira. Dorothy . C08 topouloa
- -- ~ --------- -------------- - - #-.- - - ---- - --
(Addr.-)
7th . lUGUST 61
, ______,_ d8vof ____________,_________________:.._; 19__- ---
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__ _______ D.C. My Commiulon .xpi.... ---------------------------
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