HomeMy WebLinkAbout2711 D~c1a~aUon of Oanlail• a~d Citis~~ship
TO TME STATE AND COUNTY TAX ASSESSOR,
s~ . ~uc~E couNnr, f~oR~o~: ' .
This is my d~cluation of Oomicil~ ~~d Cit~niF?ip in th~ St~t~ of Norid~ that 1~m filinp this day in ~ooord~e?a ~nd
in oonformity with Chaptsr 2ZZ. S~ttion 2~2.17, Horid~ .StatuMt.
~ w•~ tam.rly • Ipal nsid~?t of Gastonie ivorth Carolina
(City) - (Sf~h)
end I rosided at ~ 1502 DBVis PaY'k Rd. I haw chatpad my domic~le
(Stnet a~d Number)
ro~nd am snd havs baan a bona fids ~esident ~of the Stste of Florida sinoe 26 th ' day of
~anuary , ~q 71, a~ n 1406~ Georgia Ave.
(5traet and Number)
~ORT PIERCE, SAINT lUC1E COUNTY, RORIDA
and this ttatement is to be taken as my declantion of citizenship, actuai Isgal residenoe and domicile in ths Staro of Florida.
(Inse~t here any pertinent fact:, such as ssle of property or busineu, w mli~qui~msnt of employment
st former domicile, ron+ovsi of family to new domkile, purchase of hane, etc.)
(School Children) ' .
Randy Ashby - 7th Grade 2U402i _
S~
LUCIE
COUMTY FiA.
Wanda Lou - 6th Grade . RoGER POItRAS
CIERK CiRCUtr COURt
- RECORD VERIFIED
Ffe ~ ~o-~~ aM ~ti ~
~ .
: ~ ~
~
~ .
~
F
~ .
.
I FURTHER CERTIFY thst I will aomply with all othK nquinmsnb of a Ipai resident of this State.
I FURTHER CERTIFY that I have rw intentio~ to mtum to my former domicjle, arxl I intend to remain in FORT
PIERCE, SAINT LUGIE COUNTY, FLORIDA, permsnsntly. Iva dean Henderson (ffirs. Clifford)
~
~ ~
~ (N°m°)
~ .
>
~ (Address)
~
~
~
~ Sworn ro and~=ubscribsd before ms this lst ~y of February ~ ~q 71.
~ `~~~~1Ni1:1:cN~~~~~
v,~T a" : . - . .
i .
'"~~"a"~ ` ''~i
~ ~ ~ „ Notary Pubiic
~ ` ' •
~ ' ~
6y t ~ D.C. . My Commiuion expires
:
~ • y~ ~
% ~ f~ ~ ` ~
.
~''~r.~'V~~' - -
~ tT~ i~y,~~~~d i~+~lk+plicat~ ~ed eri~inal Rl~d wifh Ciwlc Cira~it Caret, and duplieat~ w~th Tax Ass~ssora
~ ~~~h~kt~~~~>>. ` . -
Y~~: = - sooK i89 ~
~ tio. 19 A
~ ' _ : Y
'~x r - y ~
. a^ ~~~~~"~'M.:~~ _ ; ~ ` _