HomeMy WebLinkAbout2698 oecla~ation Ot DOmlC!!s a~d Citisenshlp 15~.169 ~
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TU THE STATE AND COUNTY TAX A?SSESSOR. ~ ~
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51. lUC1E COUNTY, fIORI~A: ~ •
This is my decla~atio~ of Oomici'~ a~d Citizenship in ths Sta~e of fbr~de thai I am fili~p this ~ay in aooordana and
in oonformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal ~esident of OmahS Neb~
~ (~ty) (Stats)
and 1 residsd at OFFjTTT AIR FORGB ~ BASB .~~ver 1 hav~ charped my domicile
(Sheet and Number)
to end am and have been a bons fide ~esident of the State of Florida sinae istg , day of
December , 19 66 , a~ i ~ 180? Melaleuca Dr. _
(Street and Number)
FORT M~CE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence a~d domidle in the State of Florids.
pnsert hero sny pertinent fads, such as sale of properry w busineu, or relinquishment of employmant
at former domicile, removal of family to new domicile, purchsse of home, etc.)
to establish residencd ~ .
RII.ED AND REC,QRO~~..
ST.RECORD V~RlFI~h~ . "
. 15ii69
'66 DEC 27 I~I:31
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C ROGER POITRAS `
i CLERK _CIRCUIT C~URT
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I fURTHER GHtTIFY that I will aomply with all other requirernenri of a leyal res'~dent of tfi~s State.
I FURTHER CERTIFY that 1 have no intention to retum to my former domiG~e, and 1 intend to remain in FORT
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PIERCE, SAINT.Ul~i~; NTY, fIORIDA, pe~manently.
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'~,.t1 ~'~~t•'~s.~ - .
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; ; ~j~~~ _ (Name)
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- - t~ ~ John H. Acrivle~lis
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z:.,*_~"• 4-. r"_ (Acldress)
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~ •~.,r.M.~~,.~,._ - • 27th
" December ~9b6
~`~'Swort~:tb en8 wbscribed bef~re me this day of -
R~GER
U tOURT Notary Public
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gy _ C.C. My Ganmiuion exp~res
(TA b~ in dupticat~ s~ oripinal fil~d whh Cl~rlt Cuarif Couet, snd duplicat~ wilb Tax A~or.)
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