HomeMy WebLinkAbout0233 C ~ ,t(
~ecla~atlon - ot Domicile ~nd Cittzenship .
TO THE STATE AND COUNTY TAX ASSESSOR, 1224'~5
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Thi: is my daclaration of Oomidle and Citizenship in the Stats of Florida thst 1 am filin~ this day in aooordanos and
in aonformity with Chapter 222, Sattion 222.17, Florida Statutes.
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I was fo~merly s legal rosident of ~asaon Bah~A ~
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! (City) (Stats) ~ ~
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j sr~ I rosided at However 1 have changed my domidle _
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~ ro and em and have been a bona fids rosident of the Staro of Florida 'sinos ~4 ~ day of
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~ 19^~ and I reside at 1~1~ A~enne 1~
~ (Street and Number)
( l~ORT ~IQCE, SAINT WCIE COUNTY, RORtDA
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; a~d this ststament is to be taken as my declarotion of citizenship, actual legel residenoe and domidle in the Stste of Horida. 5. ~
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~ pnsert here any pertinent facts, such as sale of properry or business, or mlinqui;hment of employment ~k
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~ at former domicile, removal of family to new domiale, purchase of home, etc.)
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I ~ Applied !er wieriaaa ~itzenehip ~
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1224'75 - ~ . . . : i
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I~! ~ AND RECORDEO ~:.a : ~
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J~'•~ 20 : x~'~ • ~ ° ;'r ~ . r -
+ 1964 ~
' PM 2; 39 ~ : ~ r r ~ ~ :
0GE ` `y ssnnns:•- `
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~ R ll1CIE P~ITRAS ~~~'RK - ~;''~~~;,o,i.; • •a~~,r: ~
ST. COUN11 F~Q` ;;.;.1!~~~•.;,;~ i ~
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1 FURTHER CERTIFY that 1 will register at my local address when ths registration books reopen, and o~mply with
all other requirements of a legal msident of this Stab. f~
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1 FURTHER CERTIFY that I have rw intenYwn to rotum to my former domic~le, and I intend to ~emain in FORT
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PIERCE, SAIWI: LUCIE COUNTY, FLORIDA, permanently. .
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• SYVC~-fl .tO. af1d: ~/~CI~V~ ~Of! fTle f~{~i E~ ~ O'~ 'Ta n~ ~ r ~ 9~~• -
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CI R COURT Notary Publk
ey D C. My Gommission expires
(To b~ ~oaarhd in dupiicah and eei~inal Rl~d whh Cl~ek qraiN Courf, and dupliat~ whh Tax A~s~ora
~v~ - ;79 P~c233
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