HomeMy WebLinkAbout0049 D~claratio~ ot~ DorreiQil~ ~and Citlz~nship ,
TO THE STATE AND COUNTY TAX ASSESSOR, l~~S
51. IUCIE COUNTY, RORIDA:
This is my deciaratio~ of Oomicile and Citizenship in ths St~te of Florid~ thst 1 am fllin~ thls day in aooordanw and
in aonformity with Chapter 222. Settion 22Z.17, Florida Statuhs.
I was formerly a leyal ~esident of Reidsville _ North Carol~aa
. (City) (~at~)
and I resided at 1011~ I.iDQ Strlet ,~we~ ~~v~ my domkile
(Street and Numbe~)
to and am a~d have bee~ a bona fide ~es'~dent of the Stsro of Florids since 13t_ _ day of
J~ne , 19~, a~ i~~e ~ 530 Be~ch C~nrt
_ (Straet a~d Number) ; _ . •
c :
FORT M~CE, SAlNT LUCIE COUNTY, KORIDA ~
and this statement is to be taken as my declaration of citizenship, actual le~al re:'idenoe and domidle in ths Stat~ of Hotida.
(Insert here any pertinent facts, such as sale of propsrty or business, or relinqui:hment of employmsnt
st former domicile, removal of family to new domiale, purchase of home, etc.)
,
Bntering children ~in school
~T~
iuc'°~ i
RECORO ~VNTY• f
ERIFIEp~'
. ~l ls~~s .
AUG pN 2 ; 16
~ ~
; - Ov~P~ -
f ~~RK CIRCUIT COUR~
~
1 fURTHER CEiiTIFY that 1 will comply with all otF~er requlroments of a le~al rosident of this State.
1 FURTHER CERTIFY that 1 have no intention to return to my former domic,fle, and 1 intend to remain in FORT
PIERCE, SAINT: LUCIE .COUNTY, FLORIDA, permanently. ,
~ . - ~
:r'`. :
. ~~t~;`~::;~~t ;l;ry' ~'~a ~
.::t `'•'rf `=~}1~ ,
. . • ~ ; !y-r.-~' '-s -
. . (Name)
.
_ . . ..f';=; H~rr ra~e
• - - _ . L••~`- . . L
;~l
' + _,"''h. ~ _ I
,v.~~'~ ' ~ --'~}''}s.•, -:j ~df~i~ -
~•f•~~w` -::~'r-,~:'~r`.i•~v~~~{T • (
~ •r~"•' ~ 29tb ~ Anguat ~ • V I
Sworn to and subsuibed before me this _ day of . 19 .
• r
Ro~~e roR~us ~
C~~~ Notary Public ,
gy D.C. My Commissio~ expires
R~ b~ ~c~~ut~d in dupliub and ai~inal Al~d wNl~ Cl~eit CiraiM Co~~, and duplicst+ wi~h Tax At~~a
- s.
F
~ ~ ~ ` ;iV
---~;:4- _ - - , _ _ _ _ - ~'u~`,;.`~~:
-~~F,