HomeMy WebLinkAbout0001 1~~342
D~~ation ot Don~iQU~ a~d Citi~~nship
TO THE STATE AND COUNTY TAX A55ESSOR, ~
s~. wnE couNnr, aoRia?:
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This Is my d~daratio~ of ~omidle a~sd Citi~n:hip in th~ Stat~ of Norida that I am filinp thi~ dar in aooorda~a ~d
i~ oontormity with CMptK 222. S~ttion Z2~.17. Florida Statut~s.
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i was iormarly a Ipal ~id~nt of pf t t a~bu r g Pen n
(CIb) (Stat~)
end 1~id~d •t 123 F irst Are. .~~v~ ~ h~v~ ~hsrq~d my dani~,31~
(StrNt and NumbK)
to ~nd ~m and h~ve baen a bona fid~ rosid~nt of ths Stat~ of Horida d~oe 10 th day of
~ctob~r . 19 68a~ ~ 890 Airoao Blvd~. ,
, (Stn~t and Numbsr)
l~ORT l~CR i~AMIT tUC1E C01N~ITY, RO~A '
and this statMn~t is to be take~ as my dsdaration of citinsnship, actual lepai ~esidenos and domkile in the St~te of Horida.
pnsert hsr~. any pertinsnt fscts, wd~ as sak of property or business, or relinquishm~nt of smpioyrr~f
at tormK domidls, ranwval of family to new domicile, purchase of Fwme. ~tr.)
Bstablishing residence
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` FILED AND A~. DRD. 0~ .
ST. LUCIE C6U~TY, O~•
R~:CORD VERif E
i'71342 , `
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~ '68 OCT I 7 AM i I: N2
~ OGER POITRAS
R
CLERK CIRCUIT COURT: .
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1 RIRTHER C~tTIFY tlut I will oomply with all o~r rsquir~r~nb of a lepal r~sid~nt of thi: Sta%
1 fURTHER CERTIFlf that I have no intentbn ro retum to my former domidle, and 1 intend to remsin in FORT
PIERCE, SAINT~t~lC1E COUNIY. FLORIDA, permanenMy. `
, .t''••;r L/,~~~G~1170.t1
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^ . ~ ~ Theodore G~ l~idmer
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: y;w,a„ b,nd ,ub:a;b~d b~foro m~ th~ 17th Oc tobe r , ~ q~.
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; C~CINT Notary Pubik
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