HomeMy WebLinkAbout0313 ~ • ~ .
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~fa~ation ot Domlcil• a~d Cttisenship ~ ~
. 13~433 '
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TO YNE STATE AND C~OUNTY TAX ASSESSOR, ;
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S1.~U~CIE COUNTY. PLORIOA: 1
Thls is mr deduation of Domicfle and C~nur?ship i~ fM S~•~~ of florlda th~t 1~m fiUnp thi~ day in ~ooordana ind
in ao~famity wiM Chapter 22Z. Satian 222.17, Florida Statutes. ~
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1 was formuly • Ipal rosfd~nt of ~
(ctty) ~aa)
b00~ ~ 6th 8onat~o
' and 1 r~id~d at . ibwww I lww dianq~d my domWl~
• (StnN and NumbK)
w ai+d am and haw b~a? a bona fid~ ~id~nt of tM St~» of ftorida dnos l.~_ d~y of
~ : ~ Nov. ~64 1308 ~0 15th St
19 , and 1 ~esid~ ~t ~
(Str~t and Numb~r) ,
~ 10~T M~Cl, f~A1NT LUC~ COUNTY, ftORIDA . ~
and this statemsnt is ro be taksn a: m dedaration of citlr:~i?shi , actual i 1 rnid~no~ ~nd domidl~ In th~ StaN of Horida. ~
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(tn~ert hsn any pertinent fach, wch ~s sale of property or buuneu, or rsUnqui~~t•of ~mpio~ynMnt
~t former domidle, ~emoval of famlly to new domicile, purc~as~ of honN, Nc.) .
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~ Bstablishing residenc~
~ 132433 -
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a~,~ :'v ROGC~R ppITRAS CiE
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1 FURTHER CHtTIFY that i wiii con+plr wNh ~11 ofiNr r~qu4rn~nts ol ~ Ipal rakl~nf of N~b Stat~.
1 fURTHER CERTIFY tfiat 1 haw no iM~ntion to ~eturn 1o my form~r danlcjle, a~d 1 int~d to remai~ M fORT
PIERC~ SAINT WCIE COUNTY, FLORfOA, psrmansntly.
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L sw~om ro.nd wb~rib.d 6sfor. rr~t tht• 11 day of JanuarT i9~.. ;
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GRGNT Notary Publk
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bf? "'`''~`''e O:C. My Comnduion ~xpins
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