HomeMy WebLinkAbout0216 aaclaration ot Qomte3l~ and CitUcs~nship •
TO THE STATE AN~ COUNTY TAX ASSESSOR, 1si66~
Si . IUCfE COUNTY, FLORIOA: ~
This is my de~.la~ation of D~mmicile and Ctizenship in `he Stats of Horida that 1 am ~itir~ this day in acoordana and
in conformity with Chapter 222, Settion 222.17, Florida Statutes.
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Chicago I1 inois ~
I was formerly a legal resident of _ - ~
~~ify~ (Stst~) ~
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and I rasided at _$418 K~O7C Ave. ,~r„et;r ~ 1~v~ chanpsd my domicile (
(Stroet and NumbK) - ~
to and am and have been a bona fide rcictient of th~ Stats of Florids sinoe 14th ~y ~ ~
66 ' . " ~
Noveob~r , 19~_, and I restde et ',j,l q S~+n~v ~
_ (Street and Number) ~
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FORT NkytCE, SAINT LUCIE COUNTY, RORIDA • ~
and this statement is to be taken as my declarotion of cltizenship, actusl legal residenos and domidle ln the Staro of Horida.
(Insert here any pertinent facts, :uch sa ~!e of properry or bu:iness, ar r~linqui~ment of employment
at former domicile, ronwval of family to new domicile, purchase of home, etc.)
Bstablishing residence
F~~ED AND RECQRDFD ~ ~
ST. LUCIE COUNTY~ Ft,q,
RECORD VERIFIEO
161ss~
, '~T NOV 13 PM 2:11
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ROGER r'OITRAS
CLERK ClRCUIT COURT
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I fURTNER CERTIFY that I will oomply witfi all other rsquiremenri of a le~a) resident of this State. ~
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I.F,UiaTF~;,/7~?~.p~~~1 that I hava no intention to retum to my former domic4le, and I Entend to remain in FORT ~
_ /J• .a.`.,~, y
PIERCE;'~I~T. W~{~j!C FIORIDA, permanently.
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Oscar A. Aeckvan
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Helen Becl~an
~ 13th Nove4b~r , ~qb7' . ~
Sworn to and wburibed before me this day of
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ROG~ ~OITRA3 -
CiRCUtT C_OtJRT Notary Public
~y a~.c..~~ D.C. My Commissan expires
(Te b~ ~x,~arl~d M duplica~a swd oeioinal Hl~d w~h CIKic Ci~a~it Cew~, snd dupiieaN wilh Tax As~r.1 ~
a~K~69 ~ 212 '
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