HomeMy WebLinkAbout0243 O~luatiOn ot D01nid1~ a~d CIti:MShip j
TO TI# STATE AN~ COUNTY TAX ASSESSOR, ~
SS. ltKlE COIINTY. FlC?RIOA: o •
This is my dscia~ation of ~omkil~ and Citinnship l~ ths Stat~ of Florida that 1 am fiU~q this day in ~ooo~d~na and .
in aonformity with Chapter 22?, Ssction-22Z.17, Florids Statutes. ~
1 was ~ly a leqal rosidu~t of MYitt~Yi11Q _ Y~
(CitY) (Stah)
?110 Lois L Q ~ahaa J~ld
and 1 hsidad at $B ~ . Hewever 1 h.e~e che~q~c! my domkik
~ (Street and Numbet)
ro and an~ and have baen a bo~a fide rosjdsnt of the State of Florids sinoe lOth, day of
Aygus~ , 19.~~.. anc! 1 ros~ it
(Str~et a Numb~r)
l~ORT M~CE, S~AN~lT tUCI! COVNTY. RORIDA
and this nahnNnt is to be taken as my dadaration of citi~ship, actual le~sl res~deno~ snd domkile tn the State of Horid~.
~qnse~t hsre any peMir~eM facts, such as sale of propKty or bvsiness. or mlinqui~hment of ~mployment '
st formar domkile, romovai of family to ~aw domicils, purchs~ of home, etc.)
Batabliahing residence _ ~
~ Mi11 enter Dan McCarty High School F~LEO ANO REEORGED
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~ ' , sT. WCIE COUNTY, Fta;~.
'~;z.~j``~t~~,4~i~...,~.. ~ RECORD VERIFIEO
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` ~y~j? r ~ = \ ~ CLERK CIRCUIT COURT
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~ i RJRTHER GHtTlFY that 1 will oompiy with all other requir~rrwnri of a le~ai resident of thk Stafe.
i FURTHER CERTIFY that I have no intentwn to retum to my former domiale, and I intend to remsin in FORT
PlERCE,: ~ E COUNTY, FLORI~A, permanentfy.
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~ G~ ~~rf . (Name)
: ~ ~ p • Leslie Pogie Cioset
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~ to and wbsuibed befors me this ~and ~y ~ August , 19 66 .
ItOGtlt ~oiTRI?s _
CIRCWT Notary PuWk -
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By D.C. My Commission expitss
tTi b~ ~arhd ie dupical~ and eri~inal Al~d wilb Ci~elc CbaiN Co~ret, and dvplia~h wilh Ta~ Asw~aa
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