HomeMy WebLinkAbout0031 L;~~4a~ ~:fi~~ oi 7v::iiCii~ and ~:i~i~~:n~::i~
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: Q THE ~IA:f .~\D C: i.iti i Y TAX ASSE~OR,
~i. LUCiE COUNTY, "r:o~,~A 2164~2
Th~s +s r~ry dec~arar,on of Dom~ciie and Cit~zensti;p in the Sta~e af Fiorida that i am 4~i~ng this day in actordance and
co ;forrn;ty wi!i, Chapt~r 222, Sec!ien 222.17, Florida Stat~tes
~ Was forme~iy a Ie~a~ res~de~r of CROSSVII.LE__ ___TENNESSEE
(City; (State)
and 1 res:ded at ~ ~06 w@~t Aoenu@ _ NOrth_ , However I have cnanged my domiCile
~Street and N~mber)
and am and have oean a bona fide resident of the S:ate of Florida since __?~t~ day of
-~eptember_ _ ~9__71, a~d i ~es~de ar --------212 Gardenia A~enu~
(Street a~d Number)
; ~'ort Pierce, Floridn 33450
'rORT PIERCE, SAINT LUCtE COUNTY, FLORiDA
` ar~d this s:atement is :o oe raker, as my declaration of c;ruenship, actuai ;egai residence and domici;e in tne State of Florida.
~
~ (~nsert here any persir.ent facts, such as safe of pr~perty or business, or relinqu;shment of em~loyment
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~ at former domicile, removal of famiiy to new domicile, purchase of home, etc.)
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~ C7NTHIA DARI,ENE HAW1Q 9~ears, oi age
HAROLD EUGENE HAWN ?~ears of ego
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- ! FURTHtR CERTIFY ihat 1 wi11 comply with all other requirements of a iegal resident of this Siate.
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1 r~iFZ'i HtK CERTiFY that ! have no intention to resurn to my former domiGle, and I iniend to remain in FORT
_ _ ?~ERCE, .SAINT L~C:c CCUNTY, FIORfDA, permanently. , . ~
Ci.~_.~~ ~Q[.~~~
(D~ra. ) Ear1~nQ Hawn
(Name)
~.:i;.,.
. 212 Gnrdenin Ave, Ft. Pierce, ~'la.
. ~~i,........ J ti ~
t' - : • ~ z (A,c~~: ess) 33450
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~ " ~ ~ 1 at October ?1 ~
Siivorn ~t~ su6fcril~d be,ore me shis day of _ , 19 .
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_ ~~~~~OURT no~d~y P~o:~~
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~y _ - '~--~,~~-D.C. h1y Comm~ssion exp;res
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_ (To bo exocutcd in dupiicate aad orig"s~lai filed with Cterk Ci~cuit Court, and duplicate with Tax Assasso~.}
~:~j BoR~ 196 FAfE 31 -
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