HomeMy WebLinkAbout2812 _ s
D~clu~atlon ~ ot ~anicil~ a~ul Citit~nship '
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,
TO THE STATE ANO COUNTY TAX A,SSESSOR. ~s~,~8
5i. Ll1CIE COUNTY, fLOR10A:
This is my ctactantion of Oomicile and Citi~enthip in ths Staro of Horida that 1 am fjlirp thla day ln aooordano~ ~nd
in aonformity with Chapter 2Z2, Ssction 22Z.17, Florida Statut~s. ~
r. ~ .
1 was formarly a Ipel ro:idsnt of Tiionin~ll~ Mts~lsfld
(Cjh) (Stst~)
and 1 rosided at ~Ys Ch~ppel ROad
(Stre~t and Numbsr)
ro and am and have been a bona fids resid~nt of tM S~tat~ of ftorida sinoe lst ~y d
V Januar~ , 19 6T , a~ i~~ ~ 3073 Moringaide - B1rd.St ,Lncie Connt~
~ (StraN ar~d Numb.?) ~ , . erce, .
P 1a.
~ORT M~. SI11NT LUCIE COUNtY, IRORlDA
and this statemant is b be taken a: my dedaration of dti~enship, sdual leqsi ~esid~no~ end domidi~ in the Stits of Hortda.
pnsen here any perti~ent fach, such as sale of property or businsu, or relinc~uishmsnt of ~mploym~nt
at former domidle, romoval of family to n~w domidle, purd~ase of ~ams, etc.) -
HOI~SrBAD PURPOSffi ~ ;
:
FILED ANO RECORDED'
ST.RECORD VERIF ~ b~~
~s~.~ss
~ ~ '61 N~11 I PN ~ : 36 ~
,rcOv~R i~OITRkS
Ci.ERK ClRCUIT COURT
1 FURTHER CERTIFY that 1 will aomply wifh aii otF~x r~qulranents of a(e~ai rostdent of thb State.
1 FURTHER CERTIFY that I have no intention to ~etum to my former domic~ls, snd I intend to mmain in FORT
PIERCE, SAlNT IUCIE COUNTY, F10RIDA, permanently. ~
~
~ ~
~~lllllilt/~j• ; • _
~xancea N. Stenersen ea g. Stenersen
; ~ ~i~
`~-t'~,T,~ C~G'~~' . , ~
_=v~..y~~'''•' ' 3073 l~ioringaide Bivd.3t.Lncie Cauntry
r.,~p.~.~
~ ; - G's - = UWdres:) n . . lerce, la.
' ; _=1 p+; ~ :
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. N~ . . : . ~t ~
' ~s~ 67
'~~'.t~'~`~~nd~#~ribad before me this dey of , 19 .
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U~ f ~ . G
,,R00~~ ""~OfTR/1S .
CIRCWT COURT Wotary Public
gY - O.C. My Commission expires
(Te b~ ~oc~aNrd M dupKtaM snd eri~i~l fWd wilh CIKic Cinuif Cowt, and d~pliwt~ will~ T~oc Aa~a
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