HomeMy WebLinkAbout1365 ~ ~
, D~cla~ation ot OomN:11~ and C1tis~nshlp 1~Q~
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TO THE STATE MIC COUNTY TAX ASSESSOR, _ ~ '
ST. WC1E GOUNTY. FIORIWI:
Thii i~ my detle~stion of Domidle a~d Citis+~nahip in tiw St~t~ of Horid~ that 1 am filin~ this day in aooordana ~nd
in oonformiry with Chapter 222, Ssctbn 242.17, Florlda Stalute~.
i was formsrly a leqal r~tdent of UpPer Darbj ' pe4o.
. . Kity) (Sat~)
a~cl 1 mstded at 7249 Brent Road
~psd mY domidl~
(Str~st and Nu~)
ro and am and havs been a bona iids resfdent of the~5tat~ of Florida ~ina ..LT~._ day of
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Aptil . 19 64~ ~t 173 B Prisa Vists Blvd.
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FORT MERCE, sA1NT IUCiE C4UNTY, RORtDA •
•nd this statsment ~is to be taken as my dodaration of dtize~ship, adual leqal residena eod domidl~ i~ th~ Stat~ of Hald~.
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(Insen hers any pertinent fact:, such as sale of property or buslness, or relinquidMnsnt bf employm~nt ~
at former domicile; removal of family to nsw domidle, purchase of honns, Nc.) ;
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Bstablishieg resideec~ ? '
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1 RJRTHER CEltTIFY that I WIII comply with all ofh~t nquinnNnb of a t~p~l 6f fhis Stair. ~ t
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~ 1 FURTHER CERTIFY th~t I havs no intention to rotum to my formsr domk}is, ~nd 1 i^~.tp,~ ~ i~ FORT
~ PIERCE: SAi~'~LUGI ~OUfVTIf, FLORIDA, permenently. . _ - - ~
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3rd Februar 65 ,
Sworn to and wbscribed befon ms thts d~y of y 19 i
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ROa~ rORRAi ~
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C1RCW~ ~ Notary Publk ;
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gY . D~C. . Mr t;atiN~ion ~cplrrs 4.
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• h~ d~iCaw awd ~i~1M1 Ai~ wilb CM~Ic Cw~c+~M , aMi wilb Tau At~~~ ~
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