HomeMy WebLinkAbout1411 . _ . . . . _ . . . ' . . . , _ . - . ~ . . _ . ~..~,i
i
Dect~ra~~on of ~?or~ic~te a~d Citizensi~c~ I
. . . ;
TO THC STATE AND COUN'CY TAX ASSESSOR, '26~6~
- . .
- COUNTY; FLORIDA: ~ ~
• - ;
This is my dcclaratian of Domicite and Citizenship in the State of Fiorida ihat 1 am Tiling this day in ' ~
accordance, and in conformity witl~ Section 222.1'l, Florida Statutes.
1 was formeriy a,~egal resident of ~D nt ~ Q~
SS ES ~ut • (cs~y) ' (sa~e~ and I
resided at - . However, I have changed my domicile to ;
(Stcoet and Numbe~)
and am and have been a bona Gde resident of the State of Florida since 3 day of
~
~_~_1 7~ , 19__?__~., and I reside at 6 9 ds S. ~,c~.el~ K.. ~t2~+
, (Street aad Number) ~
~ e~ p[ ~ w f ~ a~ . S-~ _ , _ . , : ~ County, Florida,
(ca~~y) ~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(Inse~t hete anr pertineni tscts~ such as sale of property or businas. ot ~elinquishment ot emptoyment at former
, domicNe. removai of fsmity to acw domicHe. peuchase o! home. ete.j -
. . • .
- Applying for hoa~estead . . -
;
~ Entering children in school : ~
~r~-~ivu~c. ~ a,~t. . l~tJ ~^-~1~.. ~ .
. ,
` ~
~i~ ~ FlIEU AN3 R~COROED ' (
T SL ~UCtE COUMTY FLA. !
ROCEP, ~pITRAS C
~/1 ~L ~tG CIERx Ci ~~{~~i COURT
~d-c+~-.~ Z~,.~'~!^^.+~ W L+,..d~e.w . _ ?~r,nR~ Y~R~~IED -
V
LJi~.'~.,:, r~ L~.~ ~,,.;G.~,a Auc 13 12 26 PM-'73.
_ - 261,~4
' ~ .l
~ ~
~
I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and E
comply with all other requirements of a legal resident of this State. ~
I FURTHCR TIFY that I have no intention to return to my formcr domicile, and I intend to remain in `
~ ` ~ , .
" , County,
Florida, permanently. lc~rr~ ~ p~~~,
~<«,.........e• . .
.~`~dGU~Tf' ~ ClJ~d
;.•c~~}1Z ' C~~j %t ~ ~ (Nsme)
; ~~G.~~ , ~ _ .
~ ~c~= ; ~ ^ f D S. Q.~„ a - ~~z .b~
_ 4~y Q
~ i .~t ,
f~ j c : ~ ~ . (Address) ~
.;~~G~ . `
" t~~ .~'a~sdbscribed betore me this ~ 3 day of
~ A.D. 19_,~! ~
; :~s !~~r~ns«•t~... = - • .
~ c; .
120GER POITRAS, CI.ERK CIRCUI COURT . . p~1406 . I
By . D . ~ 6~OK~17 ;
.
_ . - ~
_ ~ ~
~
R . , ..u~:~-