HomeMy WebLinkAbout0427 O~al~ati011 O~f OOilliail! ~tIN1 ~1lliMihlp
1'7346$
TO THE STATE MIO COUNTY -TAX A.SSE354R,
ST. LtK1E GOtJNTY. FlOR10/1:
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Thit is my d~du~Non of GomiNl~ and Citi~nship M tM Stat~ of Haida th~t 1 am filinp this e~y in aooorda~a ~nd
in aonformity wHh ChaptK Z?2. S~dia~ 2~2.17, Haida Stah~a.
~ w~, ~~y , ~t ~ Cievtiand Ohio
Ktty) (Stat~
~ 708 Mlest Schaf f Road ~ ~w ~
FSt*..t af+d Nwnbv)
to and s~n and h~w b«n a bona fid~ ~kl~nt of t~ Stsi~ o# Fiorid~ slna ~q 1 d„? of
, 19~, S10 8ei1 Avenue
(S1nM and Numb~r)
PORT uM~lT LUCI! GOYNTY, I~ORIDA
a~d this stat~nwnf is to b~ tak~ as my c~edaratio~? of dtin~nshtp, actual Ipsl reside~o~ ~~d domkil~ in th~ Stal~ of ~id~.
qraut Mn aMr psrtin~M facls. wch as ~I~ af propsrty or business, cr mlinqui~nt of ernpio~ym~nt
at form~r domkile, ron+oval of family to n~w domici~, punha~ of home, Nt.)
Piling for hoseatead exemption snd becoaing permanent reaident -
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1 HlRTH~t Cf~tTIFY tfiat I will comply with all dF~ nquir~Ms of a ipd ~t of tlds St~h. ,
~ t RJRTHER CERTIFY that i have no intention to retum to my former domidlt, and I intenc! to remsin in FOiCf
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PI~,. ~IWL. WCIE COUNTY, FLORIDA, permsnently. ,
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~S~ryt~fo and ;ub~cribsd b.fon me this 3rd ~y ~ January 19 68.
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ROaER lOITRA:
CLiRK CI~CINT OON~T IVoRary Public
8~? D C. My Canmiuion expir~
Ri b~ ~oaaN~d 1~,~eaN awi ~ liwd wMM CMilc Ci~a~M Cw~1, aad d~r~ie~ wMM T~nc A~ra
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