HomeMy WebLinkAbout1504 ~
Q~'
at~OA O~ ~OII'1~~'rM! al'Id ~i~fiN~s~ i
3? _ t
-~..~y
TO THE STAiE ANO COUNTY TAX ASSE554R,
Sl. lUC1E COUNTY, flOR10A:
This is m~r declaration of Domic~le and Citi~ship in th~ St~h of Horida that i am fili~q this diy in aooordano~ Md
~n conformity with Chapter 22Z. Ssctio~ 2?Z.17, Horida StatuNs. -
~
I was formerlr a le~al ~esident of ~~~~>~~~c E~f! a~r.GY.rl~~~~ _
(Gty) lStat~)
and 1 resided at ~l 1f1~~~ - I~ow~var 1 have dw~p~d my cbmic3l~
(Streaf and Number)
ro and am and have been a bona fide msident of th~ Stat~ of Horida sinoe ~ day of
- . 19~~a~d I ~eside at a~ C~ ~~.c.~•~
. (Stre~t s Nun+b~r)
FORT SAWT LtK1E COUNTY /LORIDA ~~~%~-u~-~'
.
and this stateme~t is ro be taken as my dedaration of citi~snship, actual le~al residenoe ar~d domicile in the State of Horida.
~ (Insert here any pertinent facts, such as sale of proparty or business, or relinquishment of emp{qrment
at former domicite. ~enwval of family to naw domiale, purcfiase of horne, ett.)
~~1! ^ -E'<z_!_~' i~`EQ ?r9 RE ~ _
M~~C~~?~~
Qlt~ C1A~WT
R~tORO YtR1I1~Q
~ '~~~,1!
2G3~~, .
,
i -
F
4
~
€
i
6
d
~ 1 FURTHER ~HtTIFY that f will comply witfi all ofhK requir~rr»nts of a i~al resident of thit Stat~. ~
&
~ I fURTHER CERTIFY that 1 hbve no intention to retum to my former domicjle, and I intend to remain in fORT
~ -
~
~ PIHtCE, SAINT WCIE COUNTY, FLORIDA, permanently. .
~ - • t i
~ (Name)
~ . ti- % i/iA T / « y r
~
~
~ (/1~ddr~ss)
~
~
§ Sworn~tqlr~d subsaibed before me this ~ S day of , 14~...1
~ _ , v. -
~~;~ui~~,rrf,f,,
~ ~
~ . ~
~ ' •:.~i'~Mt ~ ~ r~oi~ry P~,wk
: ~;r. .
~ 8y~ ' " ~ ~ D.C. M
~ y Commiuion ~xpir~s
~ ~ ' r r~~ ;
,t %
~ ~V:
~ ~ .~a w.r a.~ u.~ c.~+, ..e ~ T.~ ~.......a
~ ~ }
~ ~ ~~~~111~ O R i.
~
~
; ~~~~s9 ?~~1503 t
~ ~ -
~ ~ = r
~ h~
~1 . .i~?°",~
~~"'r r _ ~
.r. ~ ' _ ~.LL,""~~"~-~"..< .