HomeMy WebLinkAbout0916 . . y . 164~89
Di~l~f'atlOfl O~ D01111Q11~ ~11~I CIt1ZMi111~1
TO THE STA~E M1D COUNTY T/?X ASSESSOR, -
ST. ItKIE COUNTY, FtORIDl1: .
This is my declaration of ~omicit~ a~d Gti~sr+ship 1n th~ Stat~ of Florida that i am Hlin~ this day in aooordanw and
in aonfo?mity with Chapter 2Z2, S~ttion 222.17, Florida ~atut~.
1 was forn+efiy a Ipal rosid~r~t of ~ ISI.~iD ~ ILL.
~ (~tY) - tStatt) ~ -
4zo~ ath ~
ar~d 1 rosid~d at ' Howtwr 1 haw tharq~c! my domWi~
(Stn~f and Numb~r) ~
ro and am and have been a bona Ndr rosident of th~ Stat~ of Flortda unoe 1Zth
6T ZOOS 3Sth st.
, t 9_.-, a~d i raid~ at
(Stn~t and Numl~)
l~O~T l~C~, fAMrT LUt~ COUNtY, R+ORIDA
and this :lstement is to be take~ as my dada~ation of dti~snship, actual Ipai reside~a and dQmidle in the Stafa of Horid~.
qnsert h~n any p~rtinsnt fads, wd~? as sal~ of propKty or busin~ss, or nlinqubhmKd c# ~rnploym~+t
at former domicils, rwrwval of family to new domidk, purchas~ of Iwms, etc.)
~ BNTBRII~Ki C~II.D~Bid IN PUBLIC SC80~ - _
YBNiT3 14A1tIE AD~AIL! ( 7 ~rs)
=BRMIT RIWDBI.L Z~ A1aA1`S ti ~rs~ .
F FIlEO ANO RECORDED _
A~
ST.R
~~C~~ VVaT~ EO`
. _
'61 SEP 19 PN ~ : 23
~ -16Q1-~
}iOGEF~ r 017R«`3
~ CLERK CIRCUI7 COURT -
1 FURTHER CfATiFY tfiat i will aomply with ail othK nquir~rrwnts of a i~pal taid~nt of thb Stata. -
1 RlRTHER CERTIFY that I have no intention ro retum to my former domkile, and I intend b remain in FORT
PI~RCE, SAINT WCIE COUNTY, FLORIDA, permansntly.
-
(Name)
'~~,,,~~:~I?~t::~~. a~w~sai isi
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. J' ~ ~ ~ ~ i9t1t 3~BpT. t9 67 .
'Sworn~ tP.~ wbsaibsd bsFor~ ma this day of -
. . ~ , t~ ~
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-
.
' " ~ . Notary Public
8y, D.C. My Commission t~cpiros
lTi M M~ awil ~ei~M~ AMr wili? d~t CMwN Gw~, ami d~liaN wilb Tax Aw~.1
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