HomeMy WebLinkAbout1170 D~cluation ~ DotMi~il~ a~d Citiz~nship
TO THE STATE AND COUNTY TAX AwiSE550R. `3~~ ~CO
uGa~
51. IUCIE COUNTY. FLORIDA:
This i: my decleratlon of Oomidle and Citizenship i~ th~ Stat~ of Florida that 1 am fili~q thi~ d~y in aooordana ~nd ~
in oon~mity with Chapter 22?: Section 222.17, Flo~icla Ststuhs.
1 was formsrly a le~al r~id~nt of L~~e~le. ~la'~ d'
- K~tY) (Stat~)
and 1 reaided at 3~i80 N 1~1 j6t.h 3t1"eet ~ . HowsvK 1 haw char~cl my cbmWl~
(Strwt a~d:NumbK) ~
ro and am and h~ve been a bona fid~ ~ident of t~s St.ro o~ ~ortda :tna i5~ ~Y ~
~ lP~l , 19~ , and i raid~ ~t 313 Rio Mar Dri~s
(Str~st and Numb~r)
FORT NQCE, SAINT ~t~C1E COUNTY, RORI~A
and this :tatsment is to bs taken as my declaration of ddunship, aduat Ipal residena a~d domkii~ In the Stat~ of Hortda.
(I~sert here any pe~tinent facK, such as ~le of propKty or bu~tness, or niinqui~n~+t of employm~nt .
at former domkile, r~moval of fsmlly fo n~w domidle, purchase of home, etc.)
Bstabliahing reaidenca F'ILEO AND RECOR~~B=
ST. LUCIE COUNTY, FLA:`
RECORO VERIFIED ~
154250
~st t~ z7 ~w io : 3e _ .
~Ov~R i'OITR~S
- . CLERK CIRCUIT COURT
~
~
f
~
~ ~
f.
I RJRTHER CERTIFY that i will oomply with all other roquinrrwnb af a le~ai r~ident af this Stete.
.
•~~~l~'~~HER,,fj,.~R~Y th~t 1 hsve no intentlon to retum to my former domic,ile, and i intend to remsin in FORT
- _ ~ = , ~ ~
PI~,~~A~(~!'f' ; . . ~ .fLORIDA, permanently.
`~~r•c'~,-.... ~~G'.~}.~
, ~ ~
V t i t"?Y O- ,
- ~i+ t~ f- yG ~ . . _ ,
- : -
. ~ ; Q F ~ ~ ~ : ~ - _ ~I~I~, , ~ -
: ~n~ L = ~ ~r,: ' ~ Ted Bradley Hasa .
~ ,l.,..~._ : Q.~;
• - -
(j- ~`j~'.._G
. C I E~_.. -
'ur~~t~~~~t>>'' . (Address)
.
. '
Sworn ta and wbscribsd before me this 2Tth ~y ~ I+l~*'~h ~ , 19 b7 .
ROOER rO1TRAS
~ ~ Notary Publk -
gy a~~~ ~ O.C. ~ My Commitsion ~xpiros -
Qe b~ ~M~d tA d~pWeah aud ~I fil~d wilh Ci~e1c Cinar~t Cew~, awd d~plia~ wilb Taoc A~e~a
_ gQOK ~65 FA~E 116 ,
. . _
r kR',:` -M'~eyr" fi~""G"" ~
~'.~"~'P~ . ~ ~ - ~ r~~`s~E._
I~f~' ' x . " ~ I
~.4