HomeMy WebLinkAbout2109 - _ _ _ \ . . ~ _ ~ . o'.~.~~~ii:%' _d~i.d~i+:l~.-wSiA.+c~
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~ ~ DeCi~ratlon ot Dorta1c11e and Ct4izer.A~~±!~± '
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TO THE STATE AND COUNTY TAX ASSESSOR, ~ ~ + ~ "
ST, IUCtE COUNTY. FI.ORtDA: ' -
Thi: i: my daclaration of Oomicile and Gitiser?ship in ths State of Florlda th~t I am filiny this day in aaoordance and
in oonformiy with Chapter 222, Saction 22Z.17, Florida Statutss.
~ Chaxlotte IJorth Carolina ~
1 waY formerly a teqai resident of
(Ciy) (Stete)
708 Walnut Avenue _ ' '
and I resided at - - However 1 have changed my domivle ~
_ (St~aet and Numbe~) ~
i . - 15th .
~ ro and am and have been a bona fide resident of fhe State of florida since , day of ~
April 6A 150? Ponce De Leon Pra.do
, 19 , and 1 reside at
~ . , (Sheet and Number) .
PORT PIERCE, SAINT lUC1E COUNTY, RORIDA
and this itateme~t is to be taken as my declaration of citi~ranship, actval legai residenoe and domidle in the Staro of Hortda.
qnse~t here any pertinent facn, such as sale ot property or business, or relinquishment of employment
at former domicile, rcmova( of famity to new domic+le, perrchase~of home, etc.)
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ftLED A OOK ~
Eatablieh3n ~~x#~~i~~I~~ residence 8, ~
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- 19b4 At~ 1 S pM ~ 1: 46 _ .
- aOGER POUNT~
F'LOR ~
. . . S~. LUCIE CO ~~1~~
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1 FURTHER CERTIFY that 1 will ply with
all ,other roqvirements of s lagsl resfdent of this State. ~
I FURTHER CERTIfY that 1 have no intention to ~ retum to my former domic~le, and I intend to remain in F~RT
- PIERCE, SAINT WCiE COUNT1f, FLQRIDA, permanentiy. '
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. ~ ti ~ 1 ` ~ ~ ~ ~ . (Name) /
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~ ~ ~ . • wilbur P. woir
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4 E i f~ t° 1g Au~ust 64
` Sworn ro and subscribed before me this day of - 19---•
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~ ROGER rOtiRAS ,
q~RK CUIT CCU Notary Pubik
gy D.C. My ~ommtuion expiros ,
~i ~ . R.'
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' (To b~ nc~aihd in dupiluh and ori~inal fll«! with d~lc qrarit CouA, ae~d duptkaM" w~ T"ax As~ssora
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