HomeMy WebLinkAbout0336
o R.
80~~
3~~6
5
Declaration of Domicile and Citizenship r, '-UCI[ COUN1Y, FLA.
TO THE STATE AND COUNTY TAX ASSESSOR.
S'f. LUCIE
COUNTY, ~LORIDA:
This is my dedarntion cf Domieile and CiilieIUlhip in the State of Fl(Jrida that I am fIIin:i this day in
~ccordance, and in conformity wit'l Chapter 222, S~tion 222.17, Florida Scatutes.
I Wag formerly a legal resident OL_mp___.liYATTSVILLE---u---.mm-un.--n-----m, __.__hNfI..~'!r,,_I.\t-':Q.______.'n_____
(~ty) (S~te)
and 1 reSided at _ 1906__~~~:;:~.~n_~"_~~~nn__.________m_ _ _ .. However, I have changed my domicile
. tStrKt and Numbel')
ro and am and have been a bona fide resident of the State I)f Florida since 6th ---- day of
.n______.umJ~~~~~_~tl___n__.u_____._____, 19._~;h, and I reside tit -535S.-- 7th.hSt..------.-----u-----.- _._mu_'_____n_________
(Street &J\,j Number)
____ _n_hJ~_Qr.~n.RJ ~ ~_~~____u..__m___m_m____ _._, ____.m_on_ _X.l ot!_~~n__ .m_ m_. ____ h n' m__""____ _County. Florida,
(~ty)
and this statement is to be taken as my declal"&tion of citizenship, actual legal residence and domicile in
the State of F1orida.
(lJuert here alllY pertinent i~t.a. auch as ul. of properLy or buaineaa., or relinQuiahme!lt "f employment at
former domicile, removal of family to new domicil.. pttreh... of home, ~.)
92934 ~..
rn~'1:~ ~,rcc..r;:.o
'd~'/A '-'V~~-
.: W-..~/'"~~,\
,%1 f1.At\. 7 Af'I \\. I 0
ROGEr- P!lITG~'~~ ?~'r\
(". _ \ \' f" ~ ," ~ t' II \ i 'I' ~ \. I. ~ 1>'\
..." .
\ ... . \ . d. , '.tI " : II .-,
,.", . \\} ! s. .
-<;' -')'.~.'~'~; .-.......:~./.,
/:.C{<. ~: :', ~-:;__- .'i>~.'~
: -<., . .. . '-.ii"~'..-- ~: -.
- .. . . <. <, -. .,.. .
- -< - . .. ~~ '>"".-
<,~ - '-. .~f!~~ ~~Y0- /". :.::
. ,,"'-,;3 _ . () ~.:-1 ,
-.... ~ :1/ !'!"~:~.:....,:~ ~ ,~_;"
~". 1),1 .....; .,":':'0 .,.,,,
. " I, . - . .... ....:... .
'ljll1l'U'
I FURTHER CERTIFY that I will regisur at my local addres8 when the re~tration book8 reope:a1,
a-.nd comply with all ot~~T l't'quiNments of a legal resIdent of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain
in
.lort._.ri.er.~----,
( Ctt7)
~~....-n~-Count7, Florida,
. ___.n :<~ -v-~__.________
, (N~)
Loretta Tavenner
------------------------
(AddnA )
-----,
~9DentJy.
:... '.
. . _" _.-:'.'~ ..,:;i:.~ ,1
. . _. ,",,\..,';~tl~', .
Swcm to and fu~~;~;-w.-,1.th..-day of
. ..." ~ '\ .,.......".: ,'I.'
M......t<-k' .",,~,.--, ... " A. D 61
__----,~~.~. , , . . 19___
~":)':;l. '.' "
qJ) . .'- . . \ ...'.
. . .. ." . ~
. ,
. ~;~~~".'~: '" .i~..
r. '/ ..... '.. ,':" -' -. ..'co,;- " -
!iJ ColnmiJOdlm ~~,:'--..J./Jt}t;!6"
.-- ~. "~W"f .., .~l ~~..... .....
{To be ~ta'~~~.~~ ~ ftlcd with aft amm Court, ad ftplieate witll Tu Autuor)
R.._ 31tDfilr c... PIaat ()toQ. lfIa. .-'
I