HomeMy WebLinkAbout2656 _ p~~~~tion ot Oo?rttiail~ and Citiz~~ship
TO THE STATE AND COUNTY TAX ASSESSOR, . ~v~~ai
.
SI, LUCIE GOUNTY, FLO?RIDA:
Ti?is is my declaration of Damicile and Citizenship in th~ Stat~ of Flwida that 1~m filinp thi: day in aooorda~a and
in oonformity with Chapter 222. Section 24~.1?, Florida St~tut~s.
t was formerly a taysl resident of CHICAGB ,.,ji-i-Tj~T~_____
(C~ty) (StaM)
snd I rosided at S13L I~tarth l1eIIt; C,l11~ . HowavK 1 hew charpsd my domie~ls
(Strs~t and Number)
to ~nd am and have been a bona fide roside~t of the StaM of Florids :inoe _ Z7th ~ ~y ~
OCtOblt ,~q~7 , and 1 rosids at - 1405 ,j~t,~ Av~nn~
(Str~t and Numb~r)
FORT r1ERCE. SAINT LUCii COUNTY, RORIDA .
and this :tatement is to be taks~ es my dsdaration of citizsnship, actuel tegal residenos end domidl~ in fhs Stab of Horida.
qnsan fiera any pertinent facts, wch as sale of property or bu=ine:s, or rolinquishment qf ~mptoynwnt
at former domicile, romoval of family ro ~ew domicile, peirchase of homs, etc.) .
To Place Child in S~hool
~ FI~ED AND RECORDED
• Feed Dav~3d xolins~C~ - 12th arade ST. LUCIE COUNTY. FLA.
f?FCOP.D V~Rt~t~D
• 161283
` '6T OCT 30 . p~ t2 ; A6 ~
~
f:or:~~-~ ~•u~rR.:s
C~ERK CIRCUIT COURT
t ~ ~
i
I FURTHER CERTIFY that i will oompty wNh ati other ro~uirernent= of a IeQal residsnt of thk State.
I fURTHER CERTIFY that I hsve no infentiQn to return to my former domicaia, and I intend to remain in FORT
PIERCE, SAlNT LUCIE COUN7Y, FLORIDA, permanently. . ~
~ ~w_ _ •
'-~t~/
~ (Name) Irbrtis Moli sk~
1405 Jersey Avenue
(Address)
Sworn to and wbsuibed before me this 30t11- ~y ~ OetOber i9 67 .
,``~~~~~uto~ni~~ ~ -
~RYr~ ~ ~ ~ti,fl~
ROOER ~Ot1'RAi _ `.ti' ~0~.,'G~1 fl L' ';~h,~~~~ - ~
.
• • ~ • Notary Public
' 1 ~ ~ t'~ • ~ i i
• 4.
~.~lg'~;~~ ' = :O~ ~
BY = ~ ; t?:C~ +a ' _ -My Commiuion expites ~
: . ~ ~
. ~ i1 ~r~~ ~ ~1~ ~ ~
~~~'L .1•r ~
' '
f f~ ~ ~
tTe br .x.w~.a iw dupik.~. ailt,,:.~ Cl~ek ekwh eo~r~, .nd drplia~. wNM Tax A~....e.a
~.,~,,,s;~+,~~,~a~,~~ ~168
_ ~21~0
-s - - - - - . ~
_ - - - - _