HomeMy WebLinkAbout0813 O~cla~ation ot Domiail~ and Citis~nship 1s9~'76
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FIORIDA:
This is my d~clar~tion of Domicile and Ctimnship in tht Stats of Florida thst 1 am filin9 this day in aooo~anu ~nd
in aonformity with Chapt~r 2~2, Settion 222.17, Fiorida Statutes.
I was formerly a ie~i r~~dsr+t of Oharleeton ~~st rirgiaia
~ (C1y) ~ (Stah)
1592 Dinwiddie 8treet _
and 1 rosid~d at Novv~wr 1 hav~ cha~psd my domid{e
(Streef and Numbsr)
ro and am and have been a bona fide rosident of the State of Florida sinoe 18th
?~st , 1968 , s~ i~~ ~ 618 80 llth stre~t
(Stre~t and Numbsr)
ro~ s~?~r w~c~ couNTr, ao~ow
;
and this st~tement is to ba tsken as my dsclaration of atizenship, actual Iegai reiidenoe a~d domicile in the Stste of Horida.
qnsert here any pertinent facts, such as sale of property or business, or mlinquishmsnt of empioym~nt
at formar domicile, romoval of family to new domidle, purchass of home, etc.)
Bntering Donne in the 12th grade
FIlEO qMp R
" 8tephen in the llth grade ST~RECQRD V~RTY~~~~i
~FIEO~~
~ phillip in t~ 8th grade '68 AUC 23 p~jy~~:s
. 3 • 26
ROGEP p
- CIERK ~ItRAS
c~acurr couRr
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1 RJRTHER CERTIFY thM I will aomply with sli otfier nquir~rwnts of a lepal r~id~nt of this Stat~.
1 FURTHER CERTIFY that I have no inte~tion ro retum to my #otmer domi~ile, and I intend to remain in FORT
PIEItCE, SAINT LU~IE COUNTY, FLORIDA, permanently.
~ L,~e~X.~~/
(Mame)
~ ~ f,C pG~., >nrie Vanster
:
~ v~,J~~'~~CG~p,t?'i~'i
:~~i~ 5 i~;.
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- u ; i ~ . ~ ~ i = (/0.ddr~ss)
• - ~ i ~ : Q « .
. ~n~ ~ ~ 23~ ~ug~st 68
Swei~, sobscrib~d b~fon m~ this day of - 19 . ;
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C~CYIT N~~ry Publk
li~l a~'~''~~ D.C. M~r Ganmissio~ txpira~
R. .w...~.r i~ ~a~..~i .~i.i~.~ nM/ ,rw~ cM~k arodt c.r.~. .A+ ~eN~ wiN~ Ta~ A~.~..Ka
~ ~17'~ ~ 5~5 .
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