HomeMy WebLinkAbout0710 D~alaratio~ ot Oor~laile an~l Citls~nship ~ p-
15~~'S
TO THE STATE ANO GOIJNTY TAX ASSESSOR, .
ST. U1CIE COUNTY. FLORI~A: - -
This i: my decla~stio~ of Oomidl~ ~nd Citim~il?ip in th~ St~t~ of Horid~ that I am filirp this day in sooordana !Md
in oonformity with Chapter 222. Section 22~.17, Florida Statuf~t. .
I was formeriy a IeQal rosidK?t of ~ T~~
~ (Ct~Y) (Sta») .
and I tesicled at 1000 Bat'Abill . How~ i h~w tha~q~d my domki~
(Stnet and Number)
to and am and have been a bona fids ~idem of the Stst~ of Florids sina Y~ ~Y ~
Ju~v , 1966 , and 1 ratd~ at 1910 Rap?at Pa7a D~'i~s
(Street and Nurr~)
FORT M~tCE, SAINT LUCIi COUNTY. RORIDA
and this statement is ro bs~ tsken as my dedaration of cidzenship, actual le~ai r~ideno~ and domidle in th~ Stat~ of Horid~.
pnse~t hero any pertiinent fach, :uch as sale of propery or buiineu, or nlinqui~ment of employm~nt
st iormer domicile, romoval of family ro rnw domidle, purch~s~ of home, etc.)
~ Establiahing residesice
1r~.l.l aPP~T for hoseatead " ' ~
ANO RE o ~ ~
_ sT. i.t~ci~ cou~?~
RECORO VER~RIL
'6 -1539`?'S .
l JAN 18 AN 10: 3
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C~ERK
C
RCUIT COUqT
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~ ~ 1 RJRTHER CHtTIFY that i will aomply with all o~ roquir~rrisnb of a lepal rosid~nt of this Staf~.
I FURTHER CERTIFY that I have no intention to rotum to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, pemnanently. ,
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.....~i:,~''.; (Nams)
= ~ ~ ~ _ - Oecil Fergaaon
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~'~l.~~to~i~~+d'wbscribed before me this lSth ~y ~ 1•»,•~__, iq.~~.
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.
;~~OG~ lOITRAS . .
CIRCUR COURT s Notary Publk
g ~ D.C. My Commisswn expiros
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(Te b..oacw.a in a~plk.t..nd e~i~inal fil.a wHi~ c~..t ckarit cewf. .nd d~pWaM wi11~ T.~c A~....ora
aoox164 P~~ .70~'
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