HomeMy WebLinkAbout0972 . #
~
O~cluatio+~ o! Oomfall~ a~d Citiz~nship
TO TME STATE AN~ COUNTY TAX ASSESSOR.
2C12~: ~3
51. lUC1E COUNTY, FLORIDA:
This is m~r decla~atwn of Oomicil~ and Citiz~nihip in tF?~ Stat~ of Florid~ th~t i am filinq this day in ~ooordana and
~n oonformity with Chapter 2~2. Section 2~2.17, Florida StatuMs.
1 was formerlr a le~al rasident of ~r~_Ti G/~i~ h/~.,4..id S J
(City) ~ (Stah)
and i residsd at /O ~~c-= A N r~ Flcwever 1 havt chan~ed my domi~ile
(5treet and Number)
ro and am and have been s bona fids ros'~de~t of the Stah of Florida since ~ g T~ day of
~~!A ~ y , 19..~~ , and 1 reside at %l
`1 ~ ll .~T. fT. L va i 6,/~ ?
(Street and Nun?ber)
fORT ~IERCE, SAINf LUC~ COUNTY, RORqA
and this statement is ro be taken as my declarotion of citizenship, actual legal residerxe and domicile in the State of Horida.
pnsert here any pe~tinent facts, such as sale of properry or business, or relinquishment of employment
at former domicile, removal of family ro new domicile, purchase of homa, etc.) -
~ • ~ ~
~ . _
~~~E ~f
~~OCfA~
RtCOAp Y
~~-a~
~ a ~~~~t~
2~~~'8
F
lf
!
!
i .
E
; 1 RIRTHER CERTIFY that I will oomply with all otfier requirements of s Is~al resident of tfiis State.
~
3
~
~ f FURTHEQ CERTIFY that ! have no intention to return to my former domicjle, and I intend to ~emain in FORT
~ PIERCE, SAINT U:CIE COUNTIf, FLORIDA, permanently. _
a
~
~ .
~ 1. N (Mame)
~ W _ 1.~_ JC'~o~
~ . ~Sf~ ~v.~l.~~ • /~T•.fr Lv~~a, ~=~~9 .
g ~~~ytNlitNtl%~,. (Address)
~
~ ~~f~'~'C
~ =.1' -•j:;-.. ,,OGv,~ _j~~_~•
V. \ ~ ~.t A~ ~ ~S I .y ~
x r: ' ysd before me this day of _ , 191L.
= : ~
~ _ ~~~*_ri C.d ` .
~ "y : i o~. s
~ ~ . Notsry Public
~ _ . j=
7-~i
'i / • O ~ 1 Q~
By r' D.C. My Commiuion expires
~ -
~
~
lTi b~ ~:~wNd iA dupiiesaN and ~ filyd whb Cl~Ic Gre~ri~ Caret, and drplk~h wNh Tax Atw~o~.) .
~ ~~1~9 ~ 9~
~ ?:4 ~ a -
~ . ~ ; ~u,
~ ~ ~ ~ ~
, ;
. s~ ~