HomeMy WebLinkAbout0110 D~claration ot Doml~li~ ahd Citis~nship
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TO THE STATE AND COUNTY TAX ASSESSOR, , .
Sl. U1CIE COUNTY, FIORIDA: ~
Thi: i: my declantio~ of Oomicil~ a~d Citinnship in the Stat~ of Fiorida that 1 am filirp thia day in aooorda~a ~~d
in aonfotmify with ChaptK ZZZ. S~ction 2Z4.17, Florida Statuhs. . -
1 wss formerly a leyai rosid~nt of C~nCinat~, Ohio ~
(~iy) (Stah)
and I~ided at 274 SenatQr Place Apt 12 , HowwK 1 haw char~q~d my domidl~
(Str~et a~d Numbe~)
ro and am a~d haw been a ba+a fid~ nsident of the Shte of Florida sinoe 18th ~y ~
December , 19 68, a~ n 113 Calmoso Drive. River Park
(She~t and Number)
l~O~T !lRCR SAINt L11CIE C011NTY, RORqA
and this statement is ro be taken as my dedaration of citi~snship, actuai le~al residenos and domicile in th~ State of Horida.
qnsert h~re aM? perti~ent facts, wch as sale of property or bu:iness, or mlinquishment of employment
at former domicile, ronwval of family to new domicik, purchase of horne, etc.) ~
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1 fURTHER CERTIFY M~at i wil! aomply with sll othsr nc~inrrwnts of a Ipal ~uidsnt of fhis Stah.
1. FURTHER CERTIFY that I have no intention to rotum 1~ my forme? domkile, and I to remsin in FORT
PIERCE, SAINT 1tK~E COUNTY, FIORIDA, permanently. ~
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~ _ : _ OSEP~IINE W
• (Nsme)
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. .
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' 113 Calmoso Drive , River Park
, ~a
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~ L~ ~a'' . ~ 30th ~ December 68
~ t bw~o~~l b~nd sy~su~b~d b~for~ m~ s da~? ~ 19 .
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ROOiR rOiTRAf
C~CIMT ~011RT Notary Pubik
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dy ' = D.C. My Commissio~n ~xpin~
R~ M a~aNi M~ aw~ ~i~iw~l AI~ wW~ CM~It Cr~wN Gwt. aw~ ~ wiN~ T~oc A~r~
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