HomeMy WebLinkAbout0472 O~ciaration o! Domiall~ and Citis~nshlp .
TO THE STATE AND COUNTY TAX ASSESSOR,
51. LIICiE COUNTY, FIORIDA:
Thii is my decta~atio~ of Oomiale and Citimnship i~ ths State of Norida that 1 am filirq this day in aooorda~a ~d
in aonformiy with ChaptK ~22. S~cfion ZZZ.17, Horlda Statut~s.
1 w~s formKly a Ipal nskHnt of Rantou 1 I 11; nn ~ Q
. (City) (Stat~)
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~nd ~ r~id~d .t 1326 SiCamore Lane . Hovwv.r 1 h~w chan~d my domk3k
. (Str~st and Number) ~
to and sm ar~d hsve bsa? a bona fide rosident of the Shte of florida sinoe 13th day of
Hecenber , 19_ 68 and I rosids at 912 Ausbc~r ia~lr [`-nnr „
(StnN and Number)
~~~T R~A B C Mobile Ho~aes
and this state~nsnt is to be taken as my dsdaration of dtizenship, adual le~al reside~oe er~d domkile in th~ Ststt af Horida.
pnsert hero any pertinsnt fada, wd~ as sale of property or business, or mlinqui~ment af employmsnt
at formet domicile, ~emoval of family to new domicile, purchase of home, ~I~c.)
Bntering children in school
Ril,lO AWD REC RD 0~
ST. LUCI~ COU~.
' RECORD VERIFIED ~
G~,~
~69 JAN ` a~ i0: ~e
' 1'~349'7 :
;
ROGER POITRAS
CLERK CIRCUIT COURT;
6 ~
~
I RlRTHER t~RTiFlf that I wiil cort~ly with all otfisr requirwrNnts of a lepal nsideM of this State.
~ 1 FURTHER CERTIFY fhat 1 have no intention to retum b my forme~ domicjie, and i iMe~d to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently. ,
( ~ ~ v G~Z~WS/Z
/j~~
(Nsme)
Mrs. Alan H. Corliss
( Mina)
(Address)
Sworn to and wbsuibsd befor~ ms this 6th ~y ~ ,Tanuary , 19~_:
, - - .
~ _
~c=QtIR1''-~.~ . Notary Publk
J ' ~
By ~.C. My Commission expires
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