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Declaration ;~. ~ ' ' yo~i ,~Citizsnship .
TO THE STATE AND COUNTY TAX ASSESSOR,
8t. Lu~oi• COUNTY, aORi~A:
Tfiis is my declaration of Domidle and Citixanship in the State of Honda that 1 am filing this day in eooordana and
in conformity with Chapter 222, Sacfion 222.17, Fkxida Statutes.
1 was formerly a Ipal ~residant of______-- ~~'e~~i1Q -----------------~A11---~~----------
tuM .
_~4 Pp~,~;_,~~------------------. Howewr,.i haw changed my domkile
and I resided at ______------ ~+K ~ Moab..)
r----------
to and am and haw been a bona fide resident of the State of Florida sinoe___ let --------------- day of
•ugllAt ---------------. 19_bl_, and 1 reside at __~.$$r~ ~S--_~_~~~~~4~_~e
- --------------------- (S1~..r and Nemb.-)
_-- 1rt.Pisrae Bt.Lnoie ___~____-- County, Florida,
and this statement is io be taken as my declaration of citinenship, actual legal residence and domidle in the State of Ftt+rWa.
. ^ pnaart tnra any gefinwM fac1~, wd~ as s~M of prop.rb a bwirr~ a nllnquWrnMM of ~PbY+~ ~ ~"'~ domkila,
rMnwd of frnflr to nrw dos~kilR purcf~aa. of bonM. NeJ
Est~bliahing reatiasnat
la'1.643 .
N
1952.IAN'~ ~~1:20
q ~~tlCIE COUN17. F'lYR1yri
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I FURTHER CERTIFY the I w111 register a/ my local address when the registration books reopen, and comply with all
other requirements of a Ipal residar~t of this State. `
I FURTHER CERTIFY that I haw no intention b return m my former domidls, and I intend te remain in
St.I+~°ie ---------------- ~+r+tY• Florid',
-------~ieaP~43~4----~ --------------------• ----------- ------
permanently.
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wilti'iil' ~itni~°'~
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Sworn to and wbsaibed be~orr the thb__-__4~.~:. - -
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-.: tae
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