HomeMy WebLinkAbout1324 ~ 1`?'~0251
D~Claration ot Domlall~ a~d Citis~nship _
TO THE STATE AND COUNTY TAX ASSESSOR,
Si. lUC1E GOUNTY, FIORIDA:
Thi: is my d~clantia+ of Oomicile a~d Citiz~nship in the St~t~ ~f Florida th~t I am filirq this day in aooordanw ~nd
in ca?formiyr with Ch~pter 222, S~ctio~ 222.17, Rorida Statutes.
i wu ~~~y ~ ~~t ~ Coluwbus Indiana
~ KitY) . (5tat.)
and 1 tesid~d ~t RR S- FbwwK 1 h~w ch~~q~d my domidl~
(Stcwf and NumbK)
ro and am and hsve bee~+ s bo~a fide rosident of th~ Sta» of Florida since $tpt . 6 ~y ~ .
, 19 68, and I roside at Rt . 1, Box 1?2
(Strest and Numbsr)
i~ORT l1~. SAINT tllC~ COUNYY, RORIDA `
and this atatement is ro be tsken as my dedantion of dtinsnship, actusl le~al residena and domidle in the Stafe of Horid~.
qnsert hero any pertinsnt facfs, such as sale of property or business, or relinquishment of ~mployment
et former domiclle, ronwval of family to new domiciie, pu~cha~ of home, atc.)
Piacing chiidren in school
o~ .
A ~
r .
.ar~ .
c
c'r" ~ns
j ~ co aomZ
~o ~~c~v
~ ~ ~~0~
~ 2 t*~
O D ~D ~~1'?v
C ~ • • Rf :-0
~ ~r~
~ nv
1 WRTHER GHtTIFY that I wiii aompiy wNh all otF~u nquiren~nb of a lepal nsid~nt of thb Stat~.
1 FURTHER GERTIFY that I have no intention to ~etum to my fomtier domivle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
/ ?
? ~~'!t1 ~L•i~
~ `j''j~ Yatie Burton
. . ~'`j _ (Na""e)
.ti~~ ~
_ .
, ~
. ,r.~.~ • j C • ~ ~~7~~=~
i ~'a 'r' ' ~
. : . • ? -
• ~ ri ;r ~
Sw~or~i to~1 wbscribe~! before me this 9th ~y Septembes ,}q 68 ,
, ~ n . .
ROOE! ~OITRAf
CLERK GRCUR COIIRT Notary Publk
By D.C. My Corrunission ~xpi~es
- lTe b~ ~oaarNd iw d~plicai~ and ~i~al fiMd whb Cl~k CMw~i1 Co~r~, aad drpliaN w~ Tsu A~a
_ a~ 173 P~~ 1315