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o~aluation ot Domtall~ a~d Citls~nship 15~.9`74
TO THE STATE AND COUNTY TAX ASSESSOR, •
Sl. lUC1E COUNIY. FLORIDA: -
This is my daclaratio~ of Domicilt and Citi~ship In tM Stat~ of Florida th~t ! ~m filirp thia day in aooordano~ a~d
in aonformity with ChaptK Z22. S~ction Z24.1~, Flotida Stafut~s.
~ 1 wa: forme~ly a Ipal rosidu~t of xt. 80l liev J~~'a~?
(~fY) (Sta») •
a~d 1 resided at ~ ji001a1~tls L~lie Howwer 1 haw charp~d my domWl~
(Stntt a~d Numbtr)
to and ~m arid have been a bona fid~ ~~sid~nt of th~ Stats of Horids sinoe K~ 6~.1~5 day of
1"T~ : 19 65 , snd I rosic~ at ~7 Holly ~venue
(5trest and Numb~r)
FORT M~C~, SAfNT LtlCli COUNTY, MLORIDA
and this :tat~ment i: ro bs take~ as my dedarstion of citiun~hip, actuel lepsi re~ideno~ and domidle in ths Sta» cf Floricl~.
pnsert hsre any pertinent fads, auch ss sale of propsrty or busineu, or rolinquithment of employm~nt
at formsr do+nkile, removal of family to nsw domidle, purchas~ of homs. ~tc.)
H(x~iffiTF~1D PIJI~OS$S ' ~ . .
ST.~O AND 1~_~~p p'-~
REC
RD VERIRI~~
1519`74
_ '6T JAN 18 AII ; q1~-
Ro R po~TR~a
CIERK CIRCUtT COWr1!'
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I FURTHER CHtTIFY tfiat 1 will aompiy wHh ail o~th~r requir~msnri af a Ipai ~t of this Stsfe.
I FURTHER CER7IFY that I have no intention to retum to my former danic~le, and I intend to remain in FORT
PiERCE, ~~Atl~'.'~'llft{~j~COUNT_Y, FLORIDA, permanently.
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! - ~ . _ Riahard Jordaa
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•,~;~'.`f : J . - ~ac ~OZZ,Y LV@22118. F~. _Pi~'C~~1~.
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Svvoin' ~a and subscribsd before me this day of Jmnary ~q 67 ~
_ ROGQt rOtTRl1S -
_ ~K C~CIJR Notary Publk
gy ~ • D.C. My Commiuion ~xpires
R. e. .~.~w.a ~+d o~.~ a.ao,~ ca~ co~, .aa a~a. t.~ ~a -
- 60~( PA6E ,1 ~ .
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