HomeMy WebLinkAbout1907 o~alaratlo~+ o~ oaniau~ aM! Citls~nshq~
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TO THE STATE ANO GOUNTY TAX ASS~SOR.
s1. ~uciE couNnr. aoRro~: - _ ~95f 3.~
Thi: is my d~cla~ation of Domidls a~d Giti~enship i~ tM Stat~ of Horid~ that 1 am Nlin~ this day i~ aooordano~ and
in , oo~formitir with Chapter ZZ2. S~ction 22~.17, Florida ~atut~s. ~
t was formKiy a tpal nsid~nt of Oorb~, LAIIt1~0~
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snd 1 rosid~d st Rt• Boz 191 ! . How~v~ 1 I+~w chang~d niy domidi~ .
(ShMt and Number)
ro~nd am and haw be~n a boma fide tesident of tlk Stat~ of Florida si~os , 2IId day af
-Y~~~_ .~9~, and ~ r~std. ar Pleaeur~ Oove PY. I~at 4. Plot 4 -
. ~ So. . II8 1 (5treet and Number)
lORT NiRC~, SAINT ltJCl~ COUNTY, RORI~A ~ . -
and mis sratemenr is ro oe raicen as my dxiareiiw. c~ citi~enship, achiat le~al residenoe and.domidle in ths Stat, :f Fiorida.
pnsert hsre a~y~pertins~t facti, wd~ as sale of propsrty or business, or miir.quid?ment of employn~t
st former domidls, ranwval of family to new domicile, purchase of twrrie, efc.)
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QAR'LAHD BUR~iAB d8. 7 yeare ot ags , ~
Fi~d ~ANp ~ EC RpEp ~
RESIDB~BT ~ . - - Sfi ~UCIE C~~~,
. . R~CORD yER"
~F~• ~LA.
. ~ 19 E~ ~
axiLn ~x scHOOL - . 'l~ JUL T ~ `~16 -
. _ _ - ~ ~ 22
ROG~R P
CLERK CIRCUIT
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I PURTHER CBtTIFY that 1 wil) aomply with ali other requim~rwnls of a lepal r~ideM of this -Stat~.
1 FURTHER CERTIFY that i have no intention to retum to my former domicjle, and ~1 iMend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. /~~u" -
lU1RY~~'1'H BT18~UI
- tName) -
~ Pleaoure Co~e,Pk. Lot 4, Plot 4
80. IIS #](Add~s)
S'"°rrA. to ~sr~d ;ubsuibed before me this T th ~y ~ July , 19'~_.
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~y, r D.C. My Commission expi~
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