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HomeMy WebLinkAbout2582 M+~~ . . • « v. ` . " • . ~_~~7~ ' ' /~Y~t~: Yt-~.N i •a~t a7t ~ , ~ ; , DeClar,etion ot Don~tcile a~d cttt:enship 12$543 ~ ~ ~ ; I TQ TNE STATE AND COUNTY TAX ASSESSOR. ' ~ 1 ST. ltlC1E COUIVTY, FLORIDA: , . ~ ' j Thi~ b my d~cla~ation of Oomkile and Citi~n~ip in th~ Stat~ of Florida that I~m flil~p thit day in aooorda~a at~d ~ in oonformify wIM Chaptet ZZ'2, Ssctio~ 22~. i 7, florlda Statutes. ~ ' ~ _ _ _ _ _ _ _ _ --t3~~lioa - - . - - - _ - - . _ Ohio _ , 1 wss formerly a Ipal rosider~t of - ; (Chy) (Stah) ; , ~ Route 1 . ~ a~d 1 niidsd at Hovwv~r 1 haw charpsd my domWl~ ~ (Stre~t and Numbsr) _ ~ to and am :nd haw bs~n • ba~a fids ~ident ot the Sta» of Florida stnos 11 day of ~ . i ~ ~ ~u~7 64 ~ 31.9 p• 7.3th Btreet , 19 , and f re~ldt at ~ (Street and Numb~r) . ~ r l~ORT M~CE, S~AINT ~tlC~ COUNTY, FLORIDA , ~ t • ~ and fhis statar~snt i: b bs ~taken e: my dedaratbn of ciNien~Ip, actual lspai reskkna and dornidle in th~ Stah of Horida. i ~ ~ Onsert hers any pertinent fa~cf:, such as ssle of propsrty or businsu, or roltnqui:hmsnt of employm~nt ~ ~t formar domidle, removal of family to ~ew domkile, purchs~ of homs, etc.) i ~ . # j ~t ering abildrsn .1n 1 et snd 5th t~radss _ 128543 ; . ~ ' ~ . fltEO Alltp RECO pEp . ~ . . ~ 800K . 1964 AUG 26 PM 2: 18 r,'"M. t ' ~ . ~ ROGER P~ITRAS ~ - , <<~~.........~~. . st ~ . a~ . L ClE ~pUN1I'. F[OR Oq t -1~;+y~ ~ ~<< ~ ~ ' - - 1~~.~n. ' r~it;c~,.,..~t ~V . ' p . ~ ••M_ ~ i = , ~ • ~ ~j1 ~ .ti ~ ~ ~ t . ~ . . ~ ' r j ~ - . ~ . ~ I ! • • ~ • . - ' , . . ~ ~'l''•••. . •'~~o - ' - . , . ' " , ' i ~ - . ~ , ~ - ~ ~ . - ! 1 RlRTHER CERTIFY Mwt i wiif aomply witi~ ali ott~ r~qui~t= ot • lepd r~ld~nt of this Sbt~. ~ ~ ~ ~ ~ • . _ 3 ,,~EU~~CERTIFY that t have ra intention ro retum ro my former domk~ls, and ! lnter~d b romaln 1n FORT . ~ ~~.,sntNt Luci~ ~ouNnr, fLOR1~A, ~~~,~y. _ : : . ~ . ` t, ~ ~ ; ~ ~ . t a : + ~ ` . % . ~ti ~ ~ t~ ~ : t pvame) - ~ : . . ~''".y ~ ~ E ' - lRre. Ed~rsrd Diiion _ ~ ; ~ . . ~r~) ~ , . ~ , sw~or~ a.nd wbsa;b.d b.~or. m. tht: ~ d sr ot ~ ~ i~~.. ROOER rO1TRAt ' ' q~RK R COURT p~k . ~ ~ O.C. My Cortwnission fxpins ~ ~ . . R. b. .~c.ar~.~ i~ dupac~. .~d ..tot~.l f~.a wi~lr a.~k c~t c•ewf, .uid wMb .x A.......a ~ ' ~ • ~ ~ e