HomeMy WebLinkAbout0265 • r
O~cla~atio~ ot Danicit• and Citizenship
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TQ THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE ~OUNTY, FLORIOA:
This is my decla~ation of Oomicile and Citizenship in ths State of Flo~ida thst I am filinq thi: day in acoordanal~ and
in oonformity with ~hapter 222, Section 222.17, Florids Statutes.
.
1 was formerly a legal ~esident of ~COSb Illinoia
(~itY) (Stahj
and I reaided at 322 west Pierce Strtet , tlcwsver I have chsngsd my domidle
{Street and '~I~mber)
18 ~ •
ro and sm and have been a bona fide msident of the State of florida sinoe _ day of
_~y , 19 66, and ~ reside~34 ~inney Drive
(5treet and Number)
~ M~ce, satrt ~uc~ couNrr, aaaow
and this staterr~ent is to be taken as my declarotion of citizenship, actual legal residerxe and domicile in the State of Florida.
pnsert here any pe~tinent fads, such as sale of properq or business, or relinquishment of emplayment
af fo~ domicile, removal of family to r~ew domicile, purchase of home, etc.)
$atablishing residence_ in Fort Pierce, Florida
F~It.~O AND RE~M~ .
3T~ ECORO VERIF
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'66 ,!!1~' 16 [~I 9 : ~16 -
146154
~p,~R i~O~TRAS .
C~ERK CIRCUI7 COURT
1~URTHER CEitTIFY that I will aomply with all other requiremenn of a le~al reaident of this State.
1 FURTHER CERTIFY that ! have no intention to retum to my former domivle, and I intend to remain in FORT
PIERCE, SAMI~..RUC~ COUNTY, FLORIDA, permanentty.
~a~i~lNtlttlfy
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` . , ~ _ ~ ; ~ = Hersan ~i. Lahde
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Sworn to and subscribed before me this 16 day of June ~ 19 66
ROGER rOITRAS
CLERK UR C RT Notary Pubtic
~Y D.C. My Commission expires
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Qo b~ ~x~c~M~d in duplical~ and ori~i~al Al~d with Clerlc Circuk Cour1, and duplkat~ wHh Tax AsMS~ot.)
. a~~.48 264
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