HomeMy WebLinkAbout0719 ~ - D
O~lar~tion of Domlall~ a~d Citise~shtp .
~ - 151982
TO THE STATE AN~ COUNTY TAX ASSESSOR, ~
Sl. lUC1E COUNTY. FIORIDA: ~
Thls is my decta~ation of Domidl~ and Giti~sn:bip in tM Stat~ of Flaida that 1~m filinp thi: d~y in aooordana and
in oonformity with Chapter Z2~, Ssttion 242.17, florida Statutq.
_ Poa~"t~ ~
I was fotmsrly a leqal rosid~nt of ~t ~ I" I• 701~C
K~~Y) (Stat~)
end t rosided at 1~b8 3econd ~ve. HovwvK t haw ch~n~sc! my domWl~
(StrNt a~d NumbK) `
to and am and have been a bona fide resident of the Stat~ of Florida dr~a ~Y ~
8oneta
- . 19.b~_. and 1~side d~ ~•w~"`-•• Cow~t Per~ a+_ T.ne;a
, (Str~st and Numb~~)
FORT ~l~, SAINT i1JC1! COUNTY. ~LiOR~A
and this :tatement is to bs taken a: my decis~ation of dtisAnship, actusl le~a{ nsidenos and damidb in ths Stat~ of-Horid~•
(Inssrt hem any pertinent facts, such e: sal~ of property or budn~ss.~r roltnquishmant of emplo~ym~nt
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at formar domidle, romoval of~ismily to n~w domkile, purchas~ of home, Nc.)
. - . _ . • ~ '
Ea~tablistd.ng reaide~c~ §ft~
C
E~0 ~ED
~ ~i'J~IN' i% FIA,
c~~~~F2°
Lp'P]~in8 ~or home at~ad
, '61 JAIY ; 8 p~y t: S2
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1 RJRTHER ~HtTIFY that 1 w111 oomply wHh all othsr nquinrr~ri of a Ipai r~sidenf of thb Stat~. ~
I FURTHER CERTIFY that 1 have no intention to retum to my (ormer domic3le, and 1 intend to remsin in F()RT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ ll~; ~ to and wbscribsd before me this day of JannarP ~ , 19~_.
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fO1TR/1S .
~ Notary PuWic
C~IR~ql~~ • '~es
1/
gy ~O O.C. My Commisslon ~xpi
(To M~oaouNd M d~pNcM~ and eri~iwal f~d wifb CIMk C~eaik Cowt, and drplicaN wi1M Taat A~o~.l
s~164 ~ .716 ~
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