HomeMy WebLinkAbout2016 _ _ ,
D~claration ot Oomlctle and Cittsenshlp
TO THE STATE M1D COUNTY TI1X ASSESSOR, • 133411
f
ST. WC1E GOUNTY. FtOR10A: 1
This is my decia~ation of. Danicil~ and Citizenship in th~ Stah of Horid~ that 1 am fill~p fhls day in aaoordanp ~nd ~
,
in oo~nformtty with Ch~pror 222. Ssctbn 222.17, Florid~ Statutes.
1 wss forms~ly • le~al rosident of Bprd~n ~ Ind, t
(City) (St~t~) ;
. (
and 1 rotidsd at Rt 2 . Howwer 1 haw dur~qsd my domWle ~
(Street and Number) j
to and am and have been a bona fids residant of the Staro of Florid~ ~inos , 13tb day of ~
f .
~F_bruar~r , ~q 65 ~ ,,,d ~ ~i~ n 1502 So 2?th
_ ' (Street and Numb~~) .
fORT M~CE, SAINT LUCtE COUNTY, ~tOR~A
and this statemsnt is to be taken as my daclaration of citizenship, adual legal residena and domkil~ in th~ State af Horida.
qnsert here any pertinent facts, such as ~te of property or buiiness, or rolinqui~ma~t of employment
at former domicils, removai of family to new domicile, purchaae of home, etc.) ~
' ,
Bstzblishing residency ~
Bntering Mona Lisa Gr~r~~ithe ?th grade
" ,
• i
~ FlLEO AND RECORDED ' ' `
. • :
IN • 800K ~ ~ •.!~1-s :
. ;
~ a~ . • ~r,,; ~J i
- . - - - 1955 ~EB 18 PNi 12: I i ~ • ~ _ : ~ ~ = i
ER POITRAS. CIERK V' •r y~ '
ROG f OUl~TY FIORIDA 'i~J'`~..~+rnn~•+~ '
S1. LUC E C . ~ t
=•,,,,,1 ~ ~
:
, ;
~
~
_ ~
1 FURTHER CE3CTIFY th~t I wlll oomply wNfi ali other ~equiren~enb of a tpal r~td~nt of thb Staro. i
1 FURTHER CERTIFY that 1 havs no intention to return to my former domicjle, end 1 intend to remsin in FORT
PIERCE, SAtNT LUCtE COUNTY, FLORIDA, permanently. ,
,•~tyli t~`• . ^
~ ,f
E~ ~ •~~~~ti'~~,~r ~
: ~ j •t ~ (Mems)
~ . ~ ; ` •
, _ ~ ~ Msrtha Lee Jackson
' r': . ' ~
~ • : r 1:;~;
tv
' r~u
f•~p.. •tll~dd )
Sworn to and wbscribsd brfa~ nwt this 18th ~y ~ Febru4r~ ~9~5
ROG~t r01iRAs
CfRCt~R i~l1~T Nctary pubik
~ ~ C. My Comrnissbn ~xpint
; i R~ b~ ~aac~rt~d le dvppaN I~nd wi~Mal AMd wflM CMelc Ci~e+~if Cw~l, aad drpNw~ wMM T~oc Aw~~a
j .
' 9~1. R FA .
~ • ~ R. 111 ~E ~12