HomeMy WebLinkAbout0813 D~claration ot Oomicil• and Citis~nship ~
1'737'S3
TO THE STATE AND COUNTY TAX A~SSESSOR,
1
51. LUCIE GOUNTY, FLORIDA: ~
This is my decisratioin of Domicils and Citis~nship in th~ State of Florida that 1 am filirp thi• day in sooordanoe ~nd
i~ oonformity with Chapter 222. Settion 222.17, florida Statuta.
I was formtrly a I~yal rosids~t of MANSFIBID OHIO
t~h) (Sta»)
and 1~id~d at 252 6th AVBNUB ~~~~~e
(Street and Number)
ro a~d am and have been a bona fids rosident of the State of Florida sinoe 24th dsy of
A'kY , 19 68 , and I roside at 10? INDIAN HILL.S DRIVB~PT.PIBRCB~
(Strset and Number) R UA
PORT MQ~, tA1NT UKtE COUNTY, aORIDA
and this ataterr~ent is ro be tsken as my dedaration of dtizenship, act~al legai residenoe and domidle in fhe State of Horida. ~
qnsert here any pe~tinent facts, such as sak of property or business, or relinquishme~t of employment
at former domicile, rerrwval of family to new domiale, purchase of Fwrr~e, et~c.) .
HOI~S'rEAD PURPOSBS
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F1LE0 ANQ RECOR~,~D' ~
ST. LUCIE COUN'fYEO~-~?•
RECORD VERIFI
~ l~'3'753
+sg 10 PM : g i
~ E R POITRAS
, ~{.E K CiRCUiT COURT~
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1 RJRTHER CERTIFY that 1 will oomply wHfi all oth~r roquirerr~nb of a Ispal resident of this Stah..~
1 fURTHER CHtTIFY that I have no intention to retum to my former domidle, and 1 intend to ~emain in FORT
PIERCE, SAINT LUCIE COUNTY, FIORtDA, permanently. {
~
(Mame) `
GBORGB B. DICYBRSON
~ 107 INDIAN HII.LS DRIY~,PT.PIBRCE,
~ . - (A~ddross) FLORIDA
_ti~~t~,. .'-j ~~`~I`~:~~~/~,
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:-Y ~tAb•~~r~d,*u~aibsd btfore ms thi: lOth d,y JANUARY , t9~.
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; . . ~CO~T _ Notary. Public
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BY ~ % o.c. My c«~x„~uia+ .xpir~s
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