HomeMy WebLinkAbout1700 O~ala~atlon ot Domiall~ a~d Citis~nship
TO THE STATE AND COUNTY T/~.ASSESSOR,
Si, ItJCIE COUNTY, FLORIDA: ~ ,
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This is my d~clar~tio~~ of Oomicii~ o~d Citis~nship in th~ Stat~ of Haida that 1~m filinp this day in ~ooordana a~d
in oonformiy with Chapt~r 22Z, S~ttion 2Z2.17, Florida StatuNs.
1 wss ~me~ly a Ipal resid~nt of west oallsY - New YorY
(Ci1~?) (Stah)
and 1 rosided at Hillvdtew Driv9 RD ~2 : Howawr 1'haw charpsd my domiql~
~ (StrMf and Number) _
b and sm and have bsan a bona fide rosident of the Stah of Horida sinoe ~7th day of
~ - duly ,~q~, a~ ~ 1310 liidway Road
- - (Street and Numbsr) .
I~ORT M~CE, SAINT LUCiE COUNTY, ROR~A ~
and this statement ia ro be taken as my declaration of citi~ship, actual le~al residenos and domicil~ in ths State of Horida.
qnsert he~e any perti~t facts; wch as sale of propsrty or busineu, or rolinquishment of empioym~nt
at former domicile, removai of family to nsw domicile, purchsse of home, etc.)
to enter children in echool
$lena ~
~ Yarie ~u Burlinghams f~~p AiVO RECOROEO
ST. LUCIE COUNTY. FLA.
" ~ f~~CORO V~RIF?~D
~ l9`7S9Q
- ~1Q 2q pM I : 2
~~~~R ~OITR.SS
_ C~-ERK CtRCUIT COUF~T`
~ -
.
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1 RJRTHER CERTIFY th~t I will aomply with atl other roquir~rwnts of • le~sl ~id~nt of thb Stat~.
1 FURTHER CERTIFY that I have no intention ro retum to my former domicjle, and I intend to remain in FORT
P~ERC~, SA~NT LUCIE COUNTY, FIORIDA, p4rmanently.
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~ 1310 l~idway 8oad, Fort Pierce Fla
. , -
; c~i~'` ~4 (Address)
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~""'9wQin1td`ind wbsttibsd before me this 24th ~y ~ A11QUet 19~._.
~
ROGER ~OITRAi
CIRCUIT. COURT Notary Public
.
By D.C. My Commission ucpi~
(Te L~ ~oaoul~d ie drplicat~ awd ~ fiMd wNb Cl~ek Cira* Gw~, apd d~lieaN wi1~ Tax A~~J
~ a~186 ~~698
?+e_ is
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