HomeMy WebLinkAbout2890 ! .
- acla~ation of Domiatl~ and ~ Citissnshlp~ ~
. ~61435
TO THE STATE AND COUNTY TAX ASSESSOR,
51. IUCIE COUNTY, FIORIDA:
This i: my deciaration of ~omicile and Citi:~nship in ths Stat~ of flo?id~ that ! am filin~ this day in aooordano~ and
in tonformity with Cfispter 222, Section 222.17, Florida ~Statuhs.
I was formerly a leyal resider~t of ~DRBA ~ Vl_
~City) (Stat~)
and I resided at 7105 Covelltry Rd. , my ~.~1~
(Street and Number)
to and am a~d have been a bona fide resident of the Shte of Florida sinoe lst ~y ~
October , 19 b~ , and 1 rssid~ at Za07 Mit t~~+; te Tetr~ -
(Sfreet and Numbsr) E
FORT M~CE„ SAINT LtIC1E COUNTY, IRORIDA
and this statsment is ro be taken a: my dedsratwn of dtizenship, sctupl le~ai re~idenoe and domidls in the Stat~ of ~iorid~.
(Insert here any pe~tinent facts, such as sale of ptopernr or business, or relinquishment of a~nploym~nt
at former domicile, removal of family ro n~w domiale, purchass of home, etc.) ~
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FILIHG FOR Ii~I~B.STBAD PURPO~SBS
, RE~~R~E~
f I~~V~1E COUNTY. Fl.~?•
_ gT R£CC'S~C ~,r~ FtIFIFi435
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i RJRTHElt CHtTIFY that 1 will aomply with alf othsr requirerr~ants of a lega) raidsnt of this State.
1 FURTHER CERT{fY that 1 have no intention to return to my former domicjie, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permane~tly.
.
(tVame)
.~~,~~:tiii~i~rsi;1~~~ I~RA~B R. QOI.B
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_ 1 ~ ~ G~ ~ ~
~ ~ 3rd Nove~ber 196T
_ i`' •"Sworn ~o'`j~ai~bsaibsd before ms this day of . •
r'7 ' i' ~.i ~ , • ~ .
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% _ +'i/i~ t ~ ~ ` _ . .
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- UIT Notary Public
.
gy D.C. My Commiuan expias
(To b~ ~vNd in sn~l ai~ieal fiMd whb CM~Ic qra~if Covef, and drplkN~ wilh Tax A~~.I
~ d~K168 ~2884 .
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