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259999
Declarat~on of Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Luci.~' COUNTY, FLORIDA: ~ '
This is my declaration of Domicile and Citizenship in the State of Flarida ti~at ! am Ciling this day in
accordance, and in conformity with Section 222.1 Florida Statutes.
1 was formerly a legal resident of n1~i S.~rEGe~ ~/s'is~.ssr-s ,/~~C.c,/ and I
(cicr) tsai.)
resided at S~v~'
?T~Y S~'.' . However, 1 have changed my domicile to
(Street iad NumDer)
and am and have been a bona fide resident of the State of Florida since day of
, 19____-., and I reside at / 9 cSe _ ~~R,n
- (Strcel aud NumAer)
/~j' /~iE,~Qc~ ~ ST ~!!C/E CO1111tj1, Ftorida,
tcitr) ~
and this statement is to be taken as my declaration of citizenship, actual legal r~sidence and domicile in the State
of Florida.
(Inseri here any pe~tinent fscts, such n aale ot property ot Ausinas. ot roW~quishment ot emptoyment at tormet
domicile. removal ot fsmily to new domicJe. purd?ase of Aome, etc.)
Applying for homestead .
. ~
Entering children in school ; ~lir~ ~~1-.~-~-
259999 ~
fItEO AN~ RECOROED
ST.lUC1E COUNTY I~LA.
ROC«: ?OITRAS
CIERK Ci~CUIt COURT
RE~ORD VFF.'F~EO._..~~
- J~..1T 12 3a PM'73
~
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~ 1 FURTHER CERTIFY that I will re,gister at ~my local address when the registration books reopen, and
i
; comply with all other requirements of a legal resident of this State.
i ' -
~ I FURTHER CERTIFY that I have no intention to return to my former domiciie, and I intend to remain in
~ -_r D R7' P~~ R c E S r L u c~.~ , County,
` Flo~d~~erinanently. cc''r~
t ' • ~
€ '~V.)~ t,. .C ~~p~%~', ~ ~ ' /
~ .~~•.~h~l ~ ; ~Q~ - - ~~Cl~l'C
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~o
= st ~rr,~~~
~ . . ~ = ~ /9 ,ad-t) ~/fr..~ lz~~.l,l.e~~t ~
~~i~; ~ ~ 6'~~
~ ;,,j 4 _ (wddress)
~ ~ = ~
~ ~Sii~o~p~o'~i.s,~bscribed before me this ~ 7 day of ~ ~
~ A.D. 1973 .
~
~ ROGER P ITRAS, CIERK CIRCUIT COURT
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~ By ,~G-~ (G~ D. C O it*~1 ~t~
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