HomeMy WebLinkAbout1654 - 2U34~1
O~alaratior~ ot Oomiall~ a~d Citl:~ahip ,
TO THE STAYE /WD COUNTY TAX ASSESSOR, '
Sl. lUC1E COUNTY, FlOR1~A:
Thi: is my dacluation of Oomicils and Citizenship in th~ St~t~ of Florida that 1 am filinq thi: day in acoord~na and
in conformity with Chapter .222, SMion 222.17, Fiorida Statut~s.
.
1 was forme~ly a lega! resident of~" ~ ~,~1 ~~d~~~
(City) (Stab)
and 1 resided at L / ~ However 1 have chanQsd my domitile
(Street and Number) •
ro and am and hsve been a bona fide resident of t~e Stste of Florida sinoe / / 7~ day of
, 19 7~ , and 1 roside et ~~•~~i .Oi~c~~~~~~, .
0..~.~a'~' G~'.~.~ ~3~s~
FORT Pi~CE, SAlNT LUCIE COUNTY, RORIDA '
and this statement is to be taken as my dedaration of citit,enship, actual le~al residence and domidla i~ the Staro of Florida.
Qnsen here any pertinent facts, such as sale of property or busi~ess, or tetinqvishment of employme~t
at forme~ domicile, removal of family to new domicile, purchase of Fame, etc.)
/i
~
~ ~ 2Q3461
F lEQ AND RECpRp~
i~.lUC1E COUNTY f~~
ROvER POITRAt
~ CLERk CIRCu1T CQIMT
RECOIID YERIFIEO
~IAN I~ Z 34 PM'1 ~
~ .
~
i .
E
! I RIRTHER CEitTIFY thst f will comply with al) oth~r ~equirements,of a IeQal resident of thi: State.
~ .
~ I FURTHER CERTIFY that I hsve ~ intention to retum to my former domi~ile, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. J. ~argare t Klueh (~rs . Robert J.)
I
~ /
i
~ ~a~~
~ ~
? o ; .~s~,~,~j,~~..~..,
' ~~~~.a;~ ~ ~ 33f~l23
s ~ .
~ Sworn to and subsuibed before me this / day of ~q~,
~ ,
;
~ ;~:~:.iU
~ , ly~~i
% ROiiE~'~N~
~ ' Notary Publit
~ ;r • -
~ : ~ • • . s
~ By _ ~ ~ ~ ~ • D.G. My Commiss'wn expires
, .
:a•
u
~ ; ;
~~s ; . .
, :
~ ft~;~'°'°'q~i-ii~,~ca~ .~a «i~inal fi~.a a«k ci~a~ c.~~+, .~a d~plia~. wi~ T.x A.......a
. ~ g , .
~ . ..,,,~?:s~,~,~,~~~ ° R ~.89 1
, „ so~ P~E fi49
~n,:;~~ _ ~ _ ~ - ~ = t
~ `
~ ~F ~ ; :
. : -