HomeMy WebLinkAbout1671 D~Iuation Of DOmia11~ snd CltisMShlp : j
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TO THE STATE AND ~OUNTY TAX ASSESSOR,
Sl. LUCtE GOUNTY, FLORIDA:
Thts is my declaration of Domiale and Cltiien~ip in ths Staro of Norida that I am filln~ this day ir aoaordana ~nd
in oo~formity with ChaptK 222, S~ttion 222.17, Florida Statures.
i Was t~r?~sr~r a ie9e~ rosid.~~ of ~cerne ~ Mf saouri
(c~y) l'Sta+~.)
and 1~tded at BoZ 44 . F~bw~vK ! haw charq~d my domidl~
(Street and Number)
to ~nd am and havs b~en a bo~s fide msident of ths Sta» of Florida sinoe Septeaber 9 d,y ~
, 19 68 , a~ ~ 2303 Np. 4Znd Street
(5tre~t and Nwnbsr)
1'ORT N~Q. SAlNT LUCEE COUNTY, RrORIDA
and this statamsnt is to bs taken ss my declaraYan of citi~enship, actual lepal residenoe and domicile in the State of Horida.
pnsert here any pertinent fads, such as sale of propeNy or busineu, or rolinqui~ment of ~nnploym~nt
at formK domicile, mmoval of family to nsw domicile, purd~sse of horne, etc.)
Placing chiidren in schooi
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! RJRTHER CfRTiFY that 1 will corr~ply with all otF~ roquinm~nts of a Ipal raickm af thb Stat~.
I FURTHER CERTIFY that 1 have no intention to return to my formar domtale, and 1 int~nd to remain in fORT
PIERCE, S111NT LUCIE COUNTY, FLORIDA, permans~tly.
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4~~~b~aib~d b~for~ m~ this 13th ~y of S~~f~,ember , 19~H
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~ ~toort t~on~?:
QwK C~CYIT GOIItT Notary Publk
b~r D.C. My Gommjuion ~cpir~s
R~ i» ~wwM~~ i~ ~ a~ Mi~M~I AM~ wMM CMt~ CM~aM Gwf, a~i ~ wM~ Tas A~w~,?
„ ~i73 ~is'S8