HomeMy WebLinkAbout1702 ~~rw.-• ~r+~_.:. k.:.
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• D~ala~atlo~ ot Domlail~ a~d Citis~nshlp ~
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TO TI~IE STATE ANO COUNTY TAX ASSFSS~OR, • '
ST. WdE COUMY, FIORlDA:
Th1s is my dedu~tion of Oomidle snd pt~nship In th~ Stat~ of Horlda that 1 am fiiinp thls day tn aooorda~o~ and
in aonfornnily with ChaptK 2~Z. S~ttio~ ~4Z.17, Horida Statufa.
~ 1 was for~ly a lpal natd~nt ot Gsand R~pids • I~li,cbigsa
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. (CitY) (Stat~) ,
~ ~ 52 Lexiagtoa Avenue, N.w. ~ ~w
• (Str~t and Nu~j ~
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b and ~rn ~d h~w bNn • bona Nd~ rKld~nt of th~ StNs of Florkla sina 18 day of
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October . ~q64 , i~ f~~ ~f Jeasea Beach, Star Koute ,
(StrMt ~nd Numb~~) ;
Indian =iver Drive ~
lORT SAINT L1iC1E COUNTY, RORIDA . ~
and this :tat~ms~t is to bs taken es my declention of dtiz~nshlp, actual !pa! ~ssid~no~ and domkile in th~ Stat~ of Horrida.
~pnsKt hers any pertinent facts, such as ale of properry or bu~in~ss, or relinqut~+m~nt of ~mploym~nt
at formsr domkils, removsl of family ta ~ew domic~le, purchas~ of b~r~e, s1c.)
Bstabiishing residence.
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I FUiCT1ER C'E~tTIFlf that 1 wiil oomply wlth aii ofhK r~quitwrMM~ o~ s Ip~l n~id~nl of t1~ia Stat~.
1 fURTF1ER CERTiFY that 1 have no intentio~ to ?etum ~ my formsr domidl~, +~nd 1 int~nd ta rorrNin in fOiCT
PIERC~, SAINT LlIC1E ~OUNTY, FLORIDA, psrmansnNy.
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! r~. . Burdett Barahsrt
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~ yM,a~ b~nd wb~crib~d b.to~~ m. t~s 10 Ftbruar~ 19 65
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~ ROfillt f~O1T~Af
~T . Notary Publk3_
Sf? ~.C. ~ My Conwnis~ion tnpi~
~ R~ r• ~x~M~i M drpM`.1~ a~i NI~M~1 tN~i wbl~ CMrk CiraiN Gwy d~pliaM wMl~ Tax A~r~
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