HomeMy WebLinkAbout0017 D~al~ation o! ~omiail~ a~nd Citiz~nship .
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TO THE STATE AND COUNTY TAX A~SSESSOR, -
ST. LtJC1E COUNTY, FIORIDA: ~
Thi: is my decluation af Oomidl~ a~d ptis~?ship in th~ Stab of Florid~ that 1 am filinq this day tn ~ooordu~ ux1
in oo~fo~mity with Chapt~r 222, Section 222.17, ~lorida Statu/~.
i wa: formerly s le~ai rosidMt of K~~~s Netr 7o1'Ic
- Kih?~ ' iSssta)
and 1 rasided at 12~t Av?s 3tx`eet . How~vK 1 haw chan~d my domWl~
~ (Str~ snd Number)
ro and am and have been a bona fids restdent of ths Stab o# Notids sinoe .13~h ~Y ~
Jannarl ,~q~ : end ~ ratd. at 324 Ha11 d~enna, I~vsr Parlc
(Shest and Numb~~)
lORT M~C~. SAINT LNCIi COUNTY, RORIDA _ ~ - . -
and thi: statement is to be taken as my dsdaration of dNz~nship. ~ctu~l lepal r~idence and domkile in ths Sta» of Horida.
qnsert here any pertinent facts, :uch as sale of property or busin~u, or relinqui~m~nt of ~mploym~nt , -
at fonner domicil~, remoYel of family to new domidle, purchase of homs, etc.)
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Homestead Pnrpoaea - . - -
_ f~~c aNO RE ~
sT• IUCtE COUIV~~' Fi.A.~'-- :
~ RECORD VERIFIEO ~
15~gc~ _ _ _
j '61 I~QR I 3 AM 10 :~3
I
CI,ERK CIRCUIT COURT ~ -
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1 FURTHER CHtTIFY that 1 wil! corr~ply witfi ail ottwr roquir~rwnri of a Ipai raident of thi: Stat~.
I FURTHER CERTIFY that I have no intention b retum to my former domitile, and 1 intend to remain in FORT
:~IERCE, SAINT LU~IE COUNTY, FLORIDA, permanently.
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- (Name)
ut~~ s. x~nn.eu
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Sworn ro and subsuibsd before me tfii: 13th ~y l~aroh , 19~.
r~' tt4~ ~~~T . Notary Public
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- - D.C. My Gommission ~xpins > i
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~ d~ ~ Q 1~ ,~i d~plkat~ an~ e~i~wai fWd wilii~~fidt ci~N cow+, ,ind dYpiia~. wl* T,oc A.......,~
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