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HomeMy WebLinkAbout2718 ~s:x _ ~ . . ~ Oeciacation ot Domicile and Citize~ship . ~ TQ THE STATE AND COUNTY TAX ASSESSOR, 128633 , ST. UJCIE COUNTY, FIORIDA: . This is my decla~~tio~ of Domicil~ and Citisenship tn ths State of Florida ffiat 1~m Nlinp thi~ day fn ~ooordana and i~ aonformity with Chapter ~2?, Sscfbn 2~Z.17, •Floride Statutes. ' 1 was formeriy a ipal resklent of _~~~41 Bea~h P'lO~ida (Ci1y) . (Stah) ~ ; A~52 N. Bay Roaa ~ and 1 resid~d ~t ~ HowavK 1 hav~ cha~psc! m~? domkji~ (Straet and Number) I ~ ~ b and~ am ~nd haw been a bona fids rosident of th~ State of Florida stnos 1 day of j , . ~ ~ ; ' Aliguat 196~ 1109 Or+snge Avenus , and I resids at • ' ~ (Street s~d Numbsr) lORT M~Q. S~AMIT LUGE COtINTY, fLOR~A ~ arxl thb stat~snt is to be taken as my. dedsration of dHmnship, sduat legal r~idenos and domidle i~ th~ Stat~ of Horid~. ~ ~ . ' q~wert hers any pertinem fact:, such as sale of property or bu:i~ess, or rolinquisf~ment of ~mptoyrt~nt ' at tormer domidle, ranaval of family to new ~lomiale, purchase of hane, Nc.) c'~~' -~.2i~, (~V . ; ~E~~ ~~o ~ ~ a~ , ~ ~OOK I Eetabl~leh~n8 rea~denos 1964 Q~~ 3! . pM 12: pT . ~ , a~ - 1 SROGER p01TRqs ; . • ~tlCrE COUNtr, FLORIOq ~ i ~ ~ ~ ~teri~g ohildren in eahool ~ ~ 0~~ - i . + ~ ' . l, f . . f. . , . ' i ~ `~w ~.•y..~. ~ ~ _ ~ ' " C` _ . ~ ~ S.r.. ~'f s.. . ` / . . ; . , . • ~ . • ~ ; . i , s : ' , ~ • t. ' . ~ ' ' ~ . i t ~K , ' ~ . ; .`4•t ' _ . r 1 E . _ . . ~ ~ j , ; ~ 1 FURTt~ER CHrTiFY tfi~t ! wili oomply with all ott~ nquinm~nK of a ipal raideM af !hh Stat~. y . . ~ 1 FURTHER ~ERTIFY that ! have no Intentlon io rotum to, my formsr domkile, an~ 1 intend to romain tn FORT = ; ; PIERCE, SAINT U1CIE GOUWTY, FLORIDA, psrmanenHy. , • ; , . , • ~ . } . ~ . , ~ ~ ~ ~?,t ? ~ ~ . t,~ ~ ; E~atmd 8='e~nt , ,r (Add*au) ~ J y t' ~ F . ~ _ .q ;r . , f . - ~ 1'•~~ ~•y .n ? M' i ~ S~rom to ~ wbi~ib~d b~fo~ m~ this ~r ~ ~8t 19 6~ j . , ~ . ~ . . j - - ~ ~ ~ . ~ ! ~ CIR COtIRT ~ Notary PuWk ~ I ~ ~ d!? - ~.C. • My Conrniu~ ~ucpir~s - ~:Ri 97 ~~c~~~? ' 84.:~ ' R~ b~ ~oc~c~rl~d is drp~caM aad ~ri~iw~l f~d wtlb CiMlc q~aM Gwf, asd drpikal~ wilb T~a~c A~o~J ~ - . 1 ~ •