HomeMy WebLinkAbout0356 . o~cluatlo~ o! oom1a11~ a~d Citt:~nshtp 153'y12
TO THE STII'fE ANO COUNTY TAX A~SSESSOR, _ . _
Sj. U1CIE GOUNTY, FLORIOA:
Thls 1s my declsrafion of Domicfle and Citiz~nship in th~ Stero of Florlda tMt 1 am filinq this day in aooorda~ and
in confotmity with Chspts~ 222. Settion 22Z.17, Florida Statut~s.
1 w~s formstly a lepal rrsidMt of ~~~~b~ ~ogt.~l C4rolina
(Ctty) (St~»)
and 1 ~esWed at 811 Nort~h Qiarch StY'est . FbvwvK 1 haw dtarp~d r~y do~kJM
(Stn~t and Nun~r)
ro and am and haw betn a bona f1d~ reskl~M of tM St~b of Fiorida tino~ 1~ day of
3sptembsr
, 19 u+d 1 n~WW~ et _ Rt.__ 2 Bos ~300
(Strs~t and Number)
fORT fA1NT ttlG! COUNTY, lL~ORIDA ~ .
and Mis :tatwr~sr~t i: to be taksn a~ my dedar~tion of dti~nship, actu~! Ipal raidena ind domkil* M fh~ Stat~ of Flor{da.
praert hsrs any psrtinent facts, ~uch u sai~ of propsrty or busin~u, or nlinquishmsnt of ~mploym~nt
at formK domkils, r~movil of family ro n~w domkile, purchss~ of honn~, Ne.)
H~+ISSTFID PUIi'POSBS ~ -
. ~
FILED ANO RECO ~
g'f, i.UC1E C0~
RECORD V _ R~F~L .
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'61 MRR 16 2
153'71 .
h~;,~ R i~01TR~S
CI.ERK CIRCUI? COURT
.
1 FUR71iER CERTIFY that i wi!! oomply wlth all o~lltsr nquinrr~ts of • le~l rosld~tt of this State.
1 fURTHER CERTIFY that i have no intention to retum to my former domicjle, end i iMend to ~emain in FORT
PIERCf,~S141.I~,1.UCIE COUNTY, FLORIDA, permsnently.
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S~worn Eo and wbscribsd before ms this day of l~as~1, 19~_.
ROOER rv1iRAS ~
Ct~RK GRCWT COURT Notary Public
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gY O.C. My Gom~nis:fon expiros
R~ b~ ~oaaN~d M drpliuN and oel~ieal ffi~d wilb Cl~ek Ciraiit Couei, and du~M wHi~ T~ac Atw~era
g~K1~5 ~ 355
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