HomeMy WebLinkAbout0076 ' Dacluation ot DonNalt~ and Cltis~nsltip ~ 1$?~1~34
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TO THE STATE AND COUNTY TAX I~SSESSOR. -
51. ltJC1E ~:OUNTY, FLORIDA: •
Thi~ i: my dscla~ation of Domidle a~d Citiunship in th~ Stat~ of Fiaida that i am fllin~ thi~ day in~aaoordano~ ~nd
i~ oonfomnity with Chapter 222, Section 22~.17, Florida Statuhs: , .
marl a I I rosid~nt of ~ N' T
1 was fo~ Y aqa
Ki~?) . (St~t~)
and t rasidsd at lbl Eiadel'kmmao]t Bd. HowavK 1 haw cMn~t! my domWl~
(Stnst a~d Number)
to and am and have been a bons fids ~icl~nt of the St~i~ of Floride :inoe 26 ~Y ~
Jantt,at~y , 19 67 . a~d I retid~ at 1?(A Hispana ~1v~e. .
~ ~Street and Numb~r) •
FORT M~, sA1NT UlC~ CONNTY. lLORIDA .
end this statemsnt is to be tsksn as my dedaretion of citizenship, actu~l lepal taidenoa and domicile in ths St~tt of Flarid~.
pnsen here any pe~tinent facts, :uch a: ssle of property or business, or rolinquishm~nt of empioy+n~t
st former domicile, removai of family to •~ew domidle, purchase of Iwrr~e. Mc.)
FILINd P~Odt A~Q~ES7EAD PITI~'P03a3 - , ~ -
.
: i~1l.£0 AND iiE~
' ST. WC{E COUNTY. .
RFCQRQ ~~RIFIEO
'61AUG30AN11:31
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~=.o~f a ~4~l~R~s .
CLERK C~RCUIT ~~W~~ ~ ~
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- 1 RJRTHER CHtTIFY that 1 will aotnpiy with all otF~ roquirsrrNnts of a lepal rosident of thb S!a».
1 FURTHER CERTIFY that 1 have no intention to retum to my former domicile, and I intend to remsin in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. .
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~ ~ ~w~rrj.lo~ wbsuibsd before me this day of ~ ~ •
• ~7`~~~` ` . •
. : ~ j ~ GO,~~,•
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~T Notary Public
.
gy D.C. My Commission expires
(To b.? .oo.4w.a M d~plk.~1. .n~ .rt~iwal fii~d wi11~ u«k ci~aii~ ca~et, a~d d~lieM. wiii~ T.ac A~....ora
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