HomeMy WebLinkAbout0273 155553
~ Oecl~~ation ot Oomicfi~ ~nd Clttsen~sl~ip
TO THE STATE AND COUNTY TAX ASSESSOR,
S1. LUCIE GOUNTY, ~IORIDA:
This is my decla~ation of Domicile and CitiZenship in the State of Florida that 1 am filinq this day in aooordano4 and
~n oonformity with Chapter 222, Section 22?.17, Florida Stahnes.
I was formerly a legal resident of Kansas C; ty M+ ccn»r~
(~ity) (Stab)
and 1 resided at 7618 NW AvalOn . Howevar I have chanqsd my domid~~? ,
(Shset and Number)
to and am and have been a bona fide resident of the State of Florida sinos 16th day of
Aprii ,~q 5? , a~ i reside at 1406 2epher Avenue
(Straet and Number)
FORT PIERCE, SAINT WCIE COUNTY, RORIDA
and this statement is to be taken as my decla~ation of citizenship, attual le~al residence and domidle in the Stats of Horida. ~
(Insert here any pertinent facts, such as sale of propery or buaineu, or rolinquiahment of employrnMt ~
at former domicile, removal of family to new domicile, purchase of home, etc.)
Entering Shane Paul Kluck in First Grade
. Shawn Patrick Kluck in First Grade
- - - FfLEO A~1D RECOROED' -
~~RECORO VuRNI
IEO~
+ R~8 AM 10• 01
~ 6T AP
, 155853
~
- ~30GE~ ?'O~TRt~S
CLERK CIRCUIT COURT
I RJRTHER CERTIFY that 1 wil) aomply with all other requiromsnts of a legal reside~t of this State.
I FURTHER CERTIFY that 1 have no intention to return to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
Q C~
- ~°"1°~ Mrs. James P. Kluck
;
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'y~ General Delivery r
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^~~.}'~.':s~rti,~ and subsaibed before me thi: 28th dsy of Pri1 , 19 67
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CLERI( CIRCUIT COURT _ Notary Public
gy D.C. My Commission expires
~ ' lTe b~ ~oac~rhd in d~+pUcat~ ~nd oei~inal Al~d wilb CIKk qe~arit Cov~f, and d~ptie~t~ wiTh T~c A~s~x.)
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