HomeMy WebLinkAbout1451 .
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~3~cta~~~~or~ ~xt?ii'3E~~I~; ~Ci~ CO~iZ~:~S~ft~~
TO TIlC STATE ANU COUNTY TAX ASSESSOR, 26128'7 1.
. ` ~
~ ~ COUNTY; rLOR1DA: ~ ~
This is my dcclaration of Domicilc and Citizcnship in the State of Florida lhat I am filing this day in
accordancc, and in conformity with Section 222.17, Florida SEatutcs.
1 was formerly a legal resident of ~ftTD~u RO f/6- F , LOUIS /A~v~ and I
• . (~~r) (sace)
resided at ~<< c S ST ` . However, I have changed my domicile to
~ (Street :nd Number) ~
and am and have been a bona fide resident of the State of Florida since 1 ~ « day of
v ST 19 ~
3 and 1 reside at • ~ ~ ~ S• ~S ~ ~ o ~r t
(Stteet and Number)
F o~~r- f
~ Ek t~ , S T. L vG Caunty, Florida,
- (a~r)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. • ~
(inseri he~e sny pertinent faets. such u sale of property or buslness. or relinquishment oi emplorment at tormer
domic~7q. removal ot tamily to new domicJe. purchase of dome, ete.)
- , . 26~~
Applying for homestead . ~'~tEO u~p REC~,,~ - •
ST.RO
FR Pp~jrR'~s t~l - -
Entering children in school : RfcoRO ~FR
F~FO cou~T
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~~~'f-~iJRTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY tliat I have no intention to return to my former domicile, and I intend to remain in
~ FdRT P~~,e c~ s r. L vc , County,
Tlorida, pennanently. ~~i"'~
~
~ ~ Q.
~ . (Name)
~ '(O S . /.S ~
~ (~aa«u~
~ Sworn to and subscribed before me this ~ day of ~
~ r~
. A.D. 19 /--3 . .
1tOGER POITRAS, CIERK CIRC IT COURT -
~ Ily D. ~ BOOK 2i7 PAGE1~~~
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