HomeMy WebLinkAbout1420 D~CIMAt101t Of DOIY11Ci1~ ~Illd C1t1iM~l11p •la~~
TO THE STATE ANp COUNTY TAX ASSESSt)R, ~
Si . LUCIE COUNTY, F10RIOA:
Thi: is my dectantion ot Domidle and Gitis~nship in th~ Stat~ of Haid~ that ! sm filinp this day in aooordano~ a~d
in c~nformiy with Chaptsr 222. Settion 222.17, Fiorida Statutp.
t was f~merly e Ipal msid~nt of 2~nsville Ohio
fCHy) (Stat~) -
- 1042 1rlarket ~
end I rosided st . Howewt 1 hsw tMrp~d my dOmk31~
(Stntt and Numbsr)
to and sm and have bean a bona fide rosident of ihe Stste of Plaride sinos 29 ~y ~
August 19 59 ~ 107 Solaz -
, and I resid~ at
(Str~t and Number) -
FORT IM~Ci~, SAINT IUC~ COUNTY, RORIDA
and this statsment is ro be taken as my dedaration of dtiunship, actu~l lepai resideno~ ~nd domkil~ in fFia Stat~ of HoNda.
(In~rt here a~r pe?tinsr~t fact:, such as ~ale of propsrty or busine:s, or niinqui~m~r~t of emplo~ym~nt
at former domicit~, removat of family b new domicFle, pvrchase of horne, ~tc.)
Bstablishing residence
c3 _
~
_ . ~
" ~ ~ . ~ mt"tr~t = -
- 7C~ ~y~~
~ ~ w ~m=
c~,s °c~u
. ~ ° ~ r~*~c~
~ Z A
~
_ - °c u, ~ ~~a
~ vwp°,
~ ~i v
1 FURTHER CERTIFY th~t 1 will aon~ply wffh ait otitier r~quinrrwnts of a IeQal rosiqient of this Statt.
I FURTHER CERTIFY thst I have no intention to retum to my former domiqle, and I intend to remain in FORT
PtERCE, S41NT LUCIE COUMY, FLORIDA, permanently.
•;,~},~:t:,::
~ • f- ~ ~
f ~ ~ 4,~a(
i~~ ` T " f ~
~~y
~i 1:' v' Y~~:~2, a~~
% } . •i[~i:• • ~r, .
~ 't +cc'.1 . .^''d' r~~''
~ ! I~~' i '~'.r"'i~t
~ 7~=' . Cbarles C Osborne
~ "rt~r - t _~'r:f.~. +
~ ` ' (Address)
. ~ti~.
~ J, ~i-r ~ _ "~~~i
' ~ ' . : ~ :
i . -
~ 'wbsuibed beiom me this 31 ,~y ~ INatch , 19 67
:ti
. f ~h.'
f .
~ ~'1/~' R~i - • -
p~RIC COURT Notary Publk
sY D.C. My Commission expires
{T~ b~ ~d'iw drp~icai~ a~ ai~i fiMd wiN~ Cl~k CM~a~if Cw~f, aad drp~ie~N wilb Tavc A~~a ~
- S~i65 ~14~7 _ .
_ :~.r ~ - _
°w -
+ , ,r~~
~1
.