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o~c~uat~on ot oom~a~~• ~~d chls~nsh~p - .1611.08
TO THE STA?E AND COUNTY TAX ASSESSOR, ~
Sl. lUC1E COUNTY. fIORIDA:
This is my declaratio~ of Domidle and Citirsnship in tM State of Horida that 1~m filin~ thi: day in ~ooorda~w ~nd
in oonformity with Chapter 2Z4, Settion Z22.17; Florida Statut~s. -
1 wa: formerly a le~al resident of I.as Vsgas Nevads -
K~~Y~ (5tata)
and 1 residsd at 6317 Brandy~rine Nlay ~,,,~,d R,y
(Strs~t and NumbK)
ro and am and hsve been a bona fide rosid~nt of tM Stat~ of Floride sinoe ZOth
Octobe! ,~q b? , a~ n 1704 S~ 31at street
(Street and Numb~r) •
FORT ~C~, SAINT WCIE COUNTY, ROR~A .
and this ststement i: ro be tak~n as my declaratian af citiunshlp, actusl leyal r~sidenoe and domidl~ in fhe Stat~ of Florida.
(Insert hem any pertinent facfs, :uch as sals of properry or bu:insss, or nlinquls~?m~r+t of etnploym~nt
at former domicile, romoval of family to n~w domicile, purchase of 1wrr~s, etc.) ~
Bntering lCeli~ in the 2nd grade
FILEO AND RECORD~Lp~ -
, S?. l.UC1E C VERTFIEO
Rr ~ORO 1611-~5
; ~i
; '6i OCT 23 ~ 9 -
~ .
~
~ ~a~~p ~o?= ~ovat -
~ - c~ERK ~~acv~T
1 fURTHER CfRTIFY that 1 will oompiy wlth ail othsr require~rsen~ af a lepsl rosident of thb Stst~.
i FURTHER CERTIFY that I have no intention to retum to my former domitile, and I iatend to ~emain in FOttT
PIERCE. SAIN;:l~lGt~.~UNTY. FLORIDA, permanently.
~~~t~:~~t~~sit:ri~
. ` A Ij' r .
v~~~~~~G~`''''~K: ~ etc/
~ ~Q ~~~t,~f~i ~C~..rl~.y r. .
: V ..~y . 4.~.
~~s pVame)
.t.,, ;
- • - ' = Jane Napies ( ~trs wi~.er )
: Q- : ~ r, . Oti • =
~ ~ =
: : -
. . (Addross)
C ~ . L
"'-f•~' •
''':~r:!~i;tl+'~ OCtober
Swom to and subscribed befom me this 23 rd ~y , 19~
ROGER rO11R/?S -
CIRCWT COURT Notary Public
g ~ D.C. My Commiuion expiros
(Ti w~awMd 1w d~ ana e~ fiMd wilb Ciwlc Ckaiit Cou~, and dYplie~ wi* Taoc A~~a
a~K168 ~2379
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