HomeMy WebLinkAbout0163 isis3~ ~
D~furstton ot Aomicile and Citisan~hip ~
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~t0 THE STAT~ AN~ COUNTY TAX ASSESSOR, " .
Sl , tUC1E COUNTY, F10RIOA:
Yhis is my decla~ation of Domicite and ~tizenship in ths State oi Horida that 1 am fjlin~ this dsy in aaoordanos arx! ~
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~n carfomi~y with Chapter 222. Section 2~~.17, Florida Statuta. !
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1 was formeriy a tagal rotident of J~bntgo~ery Al~lbasi
(Gify) (Sta»)
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and 1 resided at -_1~R~sc Bud ~urt . Hovwver 1 have cha~qsd my domic~t~
(Strest and Nlumber)
to and am and have been a bc~e fids mtident ot tha StaM of Floride sinoe llt~_ day of
, November ,~9 6? srxl 1 r~side at _s15 GarrisQ I.an
(Street and Numbsr) -
FORT PIERCE, SAINT LUCIE COUNTY, RORIaA
and this statement is to be taken as my declaration of citizenship, actuel la~al residenos and domiale in ths State of Florida.
(Insert here any pertinsnt facts, such s: ~le of property or businesi, ~r ~altnqui:hment of employm~nt
. at former domicile, removel of family ro new domitile, purchase of homs, etc.) ~
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_ Bntering Bobby Waqne Bd~?~rds in Third grade
of school. '
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, s 1~~~~IE R~Fi~o ~
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13 ~ 9 • 1 :
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RpGER Pi~~SRA
URT -
LERK C1R~~~~ ~0
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1 FURTHER CERTIFY tha! 1 wil! comply wjlh a!! other requlrements of a IeQal resldsM of thfs Stete.
t FURTHER CERTIFY that I have no intention to retum to my former domicjle, and 1 inter?d to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
C! [',t.c.~. ~J~ ~~t.~l a.~..~-a.i
_ (I~rs.Willie N$lva M. Bdrirds ~
(Address) ~
13tb ,v ~
...•Swacn to end subscribed before me this day of Nc~oeober ~q b7 ~ f
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. - ~ RQGER ~ITpAS
C1~RK ~l~WT CCtiRT Notary Pubiic
~x -r--~ `~f~=y~=~ ~.C. My Camrr~iuion expi~es
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_-,...(Ti~.fN ~ac~arhd iw d~rplicaN and o~rioinat fii~ wilb l.M~fc Ckarit Co~nt, and d~iple~ wi~h Tau Il~sror.j
a~ 169 ~ 16~
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