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Declaratio~ ot Domicils and Cltisa~shi 132;631 ~
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TO THE STATE AND COUNTIf TAX A~SSESSOR ~
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S`i. lt~C1E GOUNIY, FLORIDA: ~ ~
- This i: my dscluatbn of Oomicile ar~d Citizs~shtp in ths Stat~ of Horid~ that 1~m fili~•this day in ~aoordana ~nd ~
In aonformity with thaptsr ~?2, Section ~22.17, Fiorlda Statut~s. ~
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1 was formsrly s leqa! rsslda?t of Cnlumhu~. Georgia
. (C~ry) (Stat~~ .
~ Md 1~tdsd at 92? Kirklsnd Drive ~~w
(Street and Number)
b~nd am ~nd have besn a bona fWe resldent of ths Stats of Fbrida ttna lst ~y
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. April ~ ~q 64 , and 1 ros~de et 26~8 Jersep Ave _
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~ORT MERCE, SAINT LtIGE COUNTY, ltORIDA '
u+d this tt~tement i: to bs tek~n ss my declaratbn of citiunihip, actual le~aal residena and domidl~ ie Nw Stat~ of Flotida.
p~sert hsre any pertinent fsct:, such as ssle of property or butinsss, or relinqui~un~nt of ~mplaym~nt
at former domidle, removal of family to new domicile, puahase of hans, etc.)
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1 xUMasTBAD purposes .
. 132631 . . - _
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~ - f ILED AND RECORDED ~ - . ~ . .
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. - 1965 JAN 19 AM * : ~ - =
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ROGER PO ^ ' =
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RIOA - Y' ~ ' '
~ ~ ST. IUCtE COUNTr. f?.0 d ~1:::1~,,•, ~ .
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. 1 RJRTHER CdtTiFY that I will aomply with all otl~x nquinrn~nts of • lpal ~~s(d~nt of thb Stat~. ~
. f FURTHER CERTIFY that 1 havs ra intention to retum to my former domk,ile, and ~ intend to remain in FORT ~
PIERCE, SAINT LUCIE COUNTY, FIORIDA, pe~manently. ~
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(Name) eorge Natsis
2608 Jersey Avenue, Ft, Pierce,Pls. ;
. V~ldr~ss)
Swa'o to u~d wbsaibsd • m~ this`. 19th ~y _TanuarT 19~~
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ROGER ~ORRAt , ~~~fa ~ ~
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~J~R' ~ . ~ Notary Publk .
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dy? D.Cr My Comrniuion ~xpir~
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~ R~ b~ .o~.ew.d 1w dYpNeal~ wMl~ ~e1e C~wit C~wt, awi d~MeM~ ~ Tatt A~~~
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