HomeMy WebLinkAbout0847 D~claration ot DomiQ11• and Citiz~nship ~
1`73'780 ;
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TO THE STATE AN~ COUNTY TAX ASSESSOR, ~
Sl, lt1CiE COUNTY, FIORIDA:
This is my decluation of Oomicils and Citiunihip in th~ State of Fiorida thit I~m filin~ this day in aooordano~ ~nd
in oonformity with ChaptK 222, S~ttion 222.17, Florid~ Statuhs.
I was formKly e Isqai rosident of Louisvillc Kentuclcy
(City) (Sta»)
and ~~id~d at 1506 Herr Lane . However 1 have cfiar~psd my domidl~
(Sfroet and Numbe~)
to a~d am and have been a bona fide roi~dent of ths Stata of Florida :inoe lct _ day of
June , 19 68, a~ n 2711 South I5th Street
(Shae~ and NumbK)
1'ORT S~AiNT WCiE COUNTY, RORfDA ~
snd this staromsnt is ro be taksn as my declaration of citizenahip, actual Is~al ~esidenos a~d domicile in the Stste of Florids. i
(Insert here any pertine~t facts, such as sale of ~operty or business, or rolinquishment of emplayment ~
st tormer domicile, mmoval of family to new domicile, purchase of home, etc.~ ~ r
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hos~~stead exemption purposes
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~tLEO AN~ RECOR~F
A. ~
57. WCIE CVERIFIFO
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•sg ,fAN ~ 3 ~ ~
i R0~ ?OIYRAS
CLERK ~~R~V~T COURT
1 FURTHER CfR71FY that I wlll oomply wlth all other r+quir~nb of a Ipai msident of thi~ Sts».
1 RJRTHER CERTIFY that I hsve no intention to rotum to my former domiCile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently.
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Bmcaett w. Hal
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_ _ (Addross)
s.. ~ , -
_ s~
6.rom sa ~f~ ~,bsuib~d befor. m. this 13th day of _T anu ar y , 19~4
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~ lfy.~. ` D.C. My Co~wr?(saion ~xpi~s
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R• M.araNi i~ .~i .~i~M.i Al.i wiN~ q~ cierN fwwt, awr ~W.~. wt* Tavc A..«...J
a~ 1?5 ~ 845
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