HomeMy WebLinkAbout0712 . . Q
O~cl~ation of Domicile and CitisMShlp
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TO THE STATE AND COUNTY TAX ASSESSOR, -
ST. Ll1C1E COUNTY, F~ORIDA:
This is my decla~ation of Oomicits and Citiz~nship in tM Stat~ of Floride thN 1 am fili~p this d~y in ~ooordano~ and
in aonformity with Chaptet Z22. Ssttion 224.17, Florida St~tut~s.
1 was formerly a Ipal rosid~nt of T-;~-~h~ a}';
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and 1 roslded at R. D. 4 BOx 15SB my ~~~1~
(Str~t and Numb~r)
ro and sm and have been a bona fide ~~ident of tM Sts» of Florids aina 0- ~ r t day of
4ctober ~q 66 ~ a~ ~ S10 Azalea Avenue,Pt.Pierce,~la. _
_ (Stnsf and Number)
FORT N~, fA1NT LUCH COUNTY. RORIDA
and this :tatemant is to be taken ~ my declaration of citir~nship, sctud I~yal r~idencs and domidl~ in the Sta» of Horid~.
pnsert here any pertinent facb, such as sal~ of propsrty or busin~ss, or nlinquishment of smpioynw~t
at fom+er domkile, nmoval of family to nsw domidle, purcha~ of ho~r~e, Nc.)
I~OMESTBAD PURPOSBS -
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t FURTHER CERTIFY that i wlll aomply with all o~lhsr nquirom~nh of i Ipal r~ident of thls State.
I FURTHER CERTIFY that 1 have no intention to rotum to my former domkile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COdMY, FIORIDA, permanently. .
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, ,',~~~~i;.ii:t~~~j~J~,.,
' ? C . Louis B. CopestiCk Mame)
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_ ~ " ' - 510 Azalea Aveaue, Pt.Pierce,Fla.
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Y%,~~ ~ " ~ ~ - - (A~dciress)
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~~iii ~to^•eRd,~supscrib~d, bsfore me this 1 gth dsy of A r v , 19~6.~ .
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CL~RK C~CWT COURT Notary Public
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gy ~.C. ' My Gommiuion expires
R. .oo.art.a ~ a~a~s s~a «i~w.~ r~.a ,wr~ a.~lC ca+a~M ce~t, .aa d~iC.» wi~ Tax w.....ora
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