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Deciarotion
ST. tUCiE COUgT1.
Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
3t~ taw{ a ccxtutty, FLORI0/1~
This is my declaration of Domidle and Citizenship in 111e StaN of Florida that 1 am f11inR this day in eooordanot and
- in conformity with Chapter 222. S~tion 222.17, Fksrida StatuNS.
" I was formerly a Ipal resident of_~~- ------ ~ ----------------• ----I~ ~--------
-----• Howawr, 1 haw changed my domkil~
end 1 r.sid.d at ____~-3.4~ ~ ~~ t-~"-~-----------
to and am and hew been a bona fide rosWent of the State of Florida sins---~Q~..--- - - ~
19_21_, and I reside at ____~~--~-P~k
------------ Q~r?cQ~~~~---------------•
-----~~'_te_P~12~! ~~~ S~Iii~___---~-------- ~+nh• mid''
----__-- taM ______.- .
and this statemer~f ii to be takerLas my dedsration of dtizanshtp, actual Ipal nsider~oe and domidk !n the State of Florida.
pmM hw ~nr PMtYMiM feet. wd~ ~s wM d P-N~y or MNr~ a nlMquM~k d ~°r'"~ ~ ionn~ dondolMi,
wwoird of feed » near doinldM, puniMee d tour Ne t
~,stabliah xssidoac~
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1015 ~.
. AND
BOAC
1962.iAN -h PM is b8~
R06ER POITRAS, LEAK
. tT. L~K i14NTY LANIIII
1 FURTHER CERTIFY thN 1 will rpistar at my local address when ~ regWration boob naoper-, and comply with all
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ether ngvireffNnta of • Ipel re+idant ~ ~ ~~'
1 FURTHER CERTIFY that 1 haw no MNmiQn ~ return b my foma- ' +~ I iM~ftd to rMnain in
a~l~! -.--~-----«--•-~ ~ »_--_----.,_~.~C!t-~ --- ~-• Florida.
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