HomeMy WebLinkAbout2541 ~ aaluatton of oomlau~ ~nd Cltissnshlp .
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TO TME STATE ANO COUNTY TAX /I~LSE3SdR, ' -
Sj. U1GIE GOUNTY. FIORiW~?: _
Thi: is my drdaration of Oomkii~ and Citi~ship in tiw St~ro of HorWa that 1 am Hlinp this day in ~ooorda~a and
in confornnity with Chaptsr 22Z. ~ttion Z42.17, Horida StNuN;. .
1 was formKly a lepal roskl~nt of ~~r o ~ /VEw ~
(qty) tSta»)
~ L~ ~tb~H~4 ST • . ~
and 1~1dad at • HovwvK I t~vs charp~d my domic~
(Stn~t and Number)
ro and am and have been e bons fids ~ide~t of the Ststs o# Ho?ida ~ sinoe d~Y ~
~ ~ ~ . 19 ~ 0 , and 1 ro~I.de et /~I~ ~i!lEl~tdrPlT QP ,r,. ~ <</CIE ~ Fl _ _
~tn~t and Numb~) S3lIS~~
!'ORT ~IQCE. SAINT LUC~ COUNTY, RORnA
and this :taternsnt is to be taken as my dadaration ot ati~snship, actuai ie~al residenoe a~d domicii~ in ths State of Horida.
qnsert hate any pertinent fact:, such as sale of property or lwsiness, or rolinqui~+m~r?t of empk~yment
at former domicile, removal of family fo new domidie, purd~sse ot hon~e, et~c.)
=~FfLED AND-~t~~OR~~,
I~ELG y ~ St, IUCIE COUN't'~f, f~A;:
- RECORD VERIFiEO
I~'IARl~ . _ 1961.25
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~ t- . - . - - 'TO JUt 16 PN! l2 : 21
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- ROGER POITRAS
. CL~RK CfRCUIT COURTj
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! FURTHER GERTIFY that 1 will oomply with ail ottwr requinrnsnb of a le~al re:tde~t of this Sta».
I FURTHER CERTIFY that 1 have no iMention to retum to my former domirjle, and I ihtend to remain in FORT
PiERCE, SAItV~ LUCIE COUNTY, FIORIDA, pemnanently. ' - . - ~
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- 3obN I» /q/1?dFew~,
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:liliiil )y~` - _ - ~ ~ ~ - . .
r~ ~t f,~~;;• ~ .
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,.:fif~~ 19~
wbscribed before me this dsy Of
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,,z~~~~+r - _ , r: ~ Nota Publk
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r~ t~,: .f R JG~
' ~ C D.C. My Commission uspi~
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~Te b. .~x.ew.d iu d~pue.~..nd oe~.~ t~.a will~ a.~k eMwN c.wt, .ad d~plk wiM~ T.x A....~...1
No. u ~ . 6~O~~I~~ PAG~~~
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