HomeMy WebLinkAbout0811 ~aluation of Ootni~il~ and Citiz~nshlp ~
_ . ~~98`73
TO T.ME STATE AND COUNTY TAX ASSESSOR,
Sl. LtKIE COUNTY, FLORIDA:
This is my declaration of Domiale and Citiz~r~hip i~ th~ Stat~ of Florida that I~n+ filinq this day in aooordanw ~nd
in aonfo?mity witl~ Chapter 222. Ssction Z?2.17, Florida Statuhs.
I wu forms?ly a Ipal rosid~nt of B1J~outh I~td.
(CitY)
and 1~id~d at 1'S23 • Yadieol~l . F1ow~ver 1 haw chan~d my domk3l~
(8treet uid Number)
ro a~d am and have been a bona fide nsident of the Ststs of Florkla since 1Bt day of
L~n,gt ,~q~, and ~ ros~de ar 1822 Qullstrea~ 1•e~~
(Stro~t snd Number) -
l40RT ~@CE. SAMrT LI~C~ COUNIY. RiORqA
and this ststbmsnt is b be tske~ as my dedarotion of dN~enship, actual le~al rasidenoe and domidle in ths State of Horid~.
qn:ert Mro a~y perti~snt fects, such as sale af properry or business, or ~elinquishment of emplo~yment
st ~ domicile, ramovat of family to new domicile, purchsse of homs, etc.)
Sntering Jill Srbaugh in 9th graae ~
N Dan in the llth grad•
FIIED AF10 RECORp~p
_ ST: l.~Ei~ Fp ~!i'Y
~~~BR@ 1~~f~l~I~Q
_ ~
'66 ~r~~ ~S~`~'3
_ 23 PM Z .
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pnc~~ ~~QF~R~s
~~-~RK CfRCt1fT COURT
I .
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~ I FURTHER CHtTIFY that i will oomply with all .other requirarwnh af a ipal r~idem of this Stst~.
~
i FURTHER CERTIFY tfiat I have no intention to retum to my former domicGle, and I intend to ~emain in FORT
PIERCE, SAINT UKIE COUNTY, FLORIDA, permanently.
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~»ii?:1i..~.:;;." . ~
~ i~j 'Q '
. . i - ~ . ((~IAffle)
~ : ~ , - ~'y ~ - Jaok Brbaugk~
f , - .
- ~;i ; • ~ • . - ~
- . ' • ` ~ . (~C~felf)
- ;r` • J -
(~e•' : ~ \ - .
''.r s~+o~~~ i~«~~a ~~n~: ~3 dey of ~~st 19 68
~
~too~t rant~?s '
cou~ r~~ry ~,w~
/0
~~.c..~a~aur~ati rE'~.Z~
~ D.C. My Commission tupiros
R~ b~ ~oo~e~d M drpMcah aed oei~inai fiNd wMM CMiI~ Ci~wiM Cow~• aAd dnplieM~ wieb Tax AwMOra
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