HomeMy WebLinkAbout0003 . 17i344
oscla~ation of Domiall~ and Citis~nshlp .
TO THE STATE AND COUNTY TAX ASSESSOR,
Si, 1t1C1E GOUNTY, FlOR1DI?i i
This i: my d~cleratien of Oomicile and Citix~nship in tM Staro of Florid~ that 1 am filtn~ this day in aooorda~a ~d
in oonformity with ~hapter 2Z2. S~cfion 222.17, Florids Statutes.
I wa: formsrly a Ipal rosident of ~~DA~ N. Y~
(Ci~y) (Stsh)
and 1 rosidsd at B~ 118 Rt . 1 ~ i~~
(Strest s~d Numb~~)
~o snd sm and haw beK? a bona fid~ rosident of the Stst~ of Florida sinos 3rd -
June_ 68 10? S. 19th St.
, 19 , and 1 roside at
(StreN and Numb~~)
l~O~T l~RCi, SAINT LtICI~ COtlNTY, lLORIDA _
arxl thi's ttstement is b be taken as my deda~ation of dti~snship, actuel Is~al residenos and domicile in the Stats of Horida.
qnse~t hero sM? pertinent facts, such as ~le of property or business, or mlinquishmsnt of employme~t
at formsr domiale, renwval of family to new domicile, purchase of 1wrr~e, etc.)
FIl~O AND REC~RO B?
ST. l.UCIE COUNYY.
RE~CORO VERIFIED ~
1`7~.344
'68 OCT I~ AN i I: 49
I ~ ROGER ~ 1
0 TRAS .
~ CLERK CIRCUIT COURT~
i RJRTNER CERTIFY that I will aomply with all o1hK rsquir~rMnb of a lepal raident of tfii: Stm.
i FURTHER CERTIFY that 1 have no intention b retum to my formar domivle, and I intend to remain in FORT
PiERCE, SAINT 111CIE COUNTY, FLORIDA, permane~tly.
(Name)
J N H
~ ,
~
. .
_ , . ~ (Addnss)
. : . . - i BMILY . ~BI.IBR
- » b ,~~i~i~ ~ 17th ~y ~ October ~q 68
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