HomeMy WebLinkAbout0499 ~ ~ r.
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~scia~ation ot Don~iclte and Clti:e~shlp ~
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Tp THE STAIE AND COUNTY TAX ASSESSOR,
Sl. UJCIE COUNTY, FLORIOA:
This ii my daclaration of Ownidle and Citizenship in ths St~t~ of Florida that I am filirq thit day 1~ ~oootdano~ a~d
~ in aonfo?mi~y wlth Chaptsr 222, Sactbn ~22.17, Florida Stetutes.
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~ wa: tormer~y a ~eqrl ~estdent of Grenup ~ Rentuck7
~ (City) (Sta»)
~ ~nd 1 resis~sd st • ~15 Ohio River Rd; ~ ~Ve ~
tStreet and N~mbsr) ~ ' .
b a~d ~m and have been a bona fide ~ident of ths Stafe of Florida sinoe 9th day of
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Januart , 19 65, and 1 msids at Rt. 2 Box 32dC
(Street and Numbsr)
irORT NERCE, SAINT ttlClE COUNTY. RORIDA .
a~d this itstement is to be taken as my decla~ation of citi=snship, actual leqal residenoe and domkile in fhe Stats of Hortda.
(I~ssrt here a~y pe~tinent fsct:, such as sale of property or bu:iness, or rslinqyrishn4ent'ot sR?ploymsM
at former domidle, removal of family ro new domicile, purcF~ase of home, etc.)
. ENTFRINv CIiILDRFN IN SCHOOL •
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oORDED '
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~ t 1965 JGN 15 PM 2: t 8 ~
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- ~ RO ~ ER POITRAS. CLERK '
~;`~a~~• . '~v ~ ST. Lt1CIE COUNTY, fIORtDA ~ ~
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I FURTHER CHtTIFIf that 1 will aompty wlth all oMMr r~qvl~emants of a tpd nsWatf of thl: Stat~. ;
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, 1 FURTHER CERTIFY that 1 have no intention to retum to my former domkjie, and 1 intend to ~emain in FORT +
PIERCE, SAINT LUCIE COUNTY, F10RlDA, permanently. ~
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cGy ~ 1--.~---- ;
• (Name)
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~ ; ~A; • • Ashtoa Charies ;
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: Swcrn b.and wbsaibsd bsfore m~ thts 1Stb Januar~ 19 65 .
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ROG~ ?OlTRAS .
• ~f CIRCUIT CC~URT Notary Pubik ;
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~ D C. My Corr~n?ission expi~es a
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Re b~ ~vhd le dupUat~ a~d ori~i~al fii~d whb Cl~eic C~ira~it Cwe~, a~d drpliaN wMb Tax As~o~a
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