Loading...
HomeMy WebLinkAbout2017 Q~al~atlo~ 01 Oomlail~ a~d Citis~saip 1 . ~~~~6 TO THE STATE At~ COUNT1f TAX ASSESSOR. s1. wa~ cotn+mr. aoRia?: ~ Tha i: m~? d~dantion of Domicil~ ~rd pt1~n~F?ip in th+ Sut~ of Florida that 1 a+n fili~p ~hls dsy in ~ooordana and i~ oor~formlty with Chapt~r 222. S~ction ~42.17. Fiaida ~~tuNs. ~ ~ w.s fon+~~r . I.q.~ r~sid.M of T~r~ . ' (Ctb) lStat~ and 1 ratW~cl at 'Reut. l An: I~bw~vK t hiw d1~rq~d Iriy cfomidi~ . (St~t arx! Nun~) ~ " ro and am .and haw bNn a bona fid~ ~id~nt of 1h~ St~t~ o# Norida d~ at ~ d~y af ~n~et . , 19~Q, a~d 1 raid~ ar 610 H~rnande 8t. sa et S~nt.~tl~, (Slrwf snd Nu~) ~ - ' ~ ~ and thls st~Mrrwnf is ta b~ tak~n as my d~dsratior~ of dti~hip, acfual I~pal ~~kN~~ a~d domkil~ in th~ Statr of Horlda. - qrqert het~ ~r~y ps~tine~t fxts. wch as sal~ of propKty or bu~MSS, or nltnqui:h~r~nt of employn~e~t . at formsr domidls. nmov~l of family /o n~w domidi~, purcha~ of hane, ric.) ~ to enroll ohildr~n in ~ohool , ~ RIt„l~:~p..~ - - ~ - ~ ~ ST FCO~Rp . . V~R 3Jbil Y. I~ona 12 ~ ?Fl~p - 70 28 ~~w~,~? l~ioh`~i s. io - i s ' - ROGER p ~ - CLFRK CtkCU jT ~ ~~T~ 1 FURTI~ER G9tTlFY tFut i will oomply with ~i o~ nqutr~rr~nts of a fpil r~W~m of th4 S~. I~ ~ ! FURTHER _CEitZ1fY .that I haw no intention ~ ntum ~ my former domiait. s~d l lntuid ~o nmsi~ in FORT ~ PI~tCE. SAIAI~ 1.~J~E,~iY, R.4R10/?. Perrr»~ent1Y• ~ . ~ - _ ~ € - - . r - - . ~ . . jf . . ~ " . 610 He andn 3t_ ~ _ . - ~ S~rorn Uq:+~¢,~btc¢b~d ~Rfoti erw this 2Ati~ _~u~ t . 19~.II. `;z•'..~, i i~'~-y;`~~i,`i:s~'~', - . s - . - =y _ ~ :.~.;e~~{; - ,1„~~. - . - . {j~s~.r - . r ~ Z ' _ . ` - ~ = ~ Notary Publk ~ . 8y - . _ + O.C. IM~? C~em~i~sion ~xpit~ ~ - ; % i r ~ _ ~ g ~ :s' f If'- ; ~ ~i - " . ~ - r,, ~ . _ R• 4~'` ; t~~ a~i «yiw~l ~i wl~ a~ei~ cb+aae c~wt. .wi ~IieN. wilM T.ec w......ra F ~ 8~ ~8~ ~~4 » ~ - ~ . _ -