HomeMy WebLinkAbout1689 ~ D~IaratlQn ot Domiaii~ a~ Citis~nship
~ .150~3:~
TO THE STATE AND COtJNTY TAX ASSESSOR, ~
Sl. lUC1E COUNTY. t~ORIDA:
This is my declaratio~ of Do+nidle and Citi~snship i~ tFw Stah of Florida that I~m filinq thi~ day i~ acoordino~ a~d
in aonformiy with Chapror 22Z, S~ction 2Z2.17, Florids Statutts. .
I was formeriy e(pal msid~?t of 9o~th Salsn l~ew YQrY
~ tCitY) (S~ah)
and I ~eslded at ai~bert strast Hown,.r ~ haw chan~.d my domtd~•
tShMt and NumbK) . .
ro a~d sm and have been a bona fide nsident of th~ Stah of Florids sino~ l~~ ~Y ~
Augi~et 19 6? i~~ „ 3141 lla~lor Dri~•
~ (Stn~t and Numbsr)
~ORT N~CE, SAINT LI~Ci! COUNTY, RORmA
and this staternent is b be taken ss my declaration of dtizsnship, ~ctual Ipal r~id~no~ ~nd domidle in the Stat~ of Florid~•
(Inse~t here any pertinent facts, wch as ~le of propsrty or busin~u, or nlinquishmMt of ~nploym~nt
et former domicile, removai of family ro nsw cbmicile, purchas~ of homs, dcJ ~
.
fflt~~ ~N CpUNT~~ A'
$otabliehing reei~enos ' sT.RE
pR~; uFR~F~E~
~ • Ig
: '61 OCT ~6;~~~
- f;Or~R . t~tTRAS
_ EiERK CIftCU1T COURT
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~ 1 FURTHER CHtTIFY that I wili compfy with all other reguinrnsMS of s Ipal roside~t of thb Stata.
~ FURTHER CERTIFY that 1 have no intenYwn t~o return to my former domic3le, and 1 intend to romain in FORT
PIERCE. SA 41E COUNTY, FIORIDA, permanently.
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;i~-~~cG ' - (N°"'°) Doh~a
~ q~~r'~`Vt~'o':~~ Riohard
,C~;~'~;,17~ n : ~t=`y,
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. . ~lsa Doh~a
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.'f~,~n~;~':t+d.~wb:cribea k3rfor. ms this 6th ~y ~ Ootobsr 19 .
ROOt~ rO1TRA~
CIRCt1R CO~IRT Notary Pubik
gy ~-~-G O.C. My C«nmission expi~
R. b. .oc.aa.d i~ drpNc.~..~i .e~i~ t~i wili~ a~.~lc c4w~it c.w~, .ud drplicah wil~ T.~c A.....e.a
~168 P~16~4
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