HomeMy WebLinkAbout1746 it .
Dc~~aration ot Gomiciie and Citiz~nship
i O 7NE STATE ANt7 ~OI;NTY 7AX ASSESSOR, ~~~~C~
J
51. IUCIE CO'v'.TY, FiORIDA. ~
Th~s ~s n:y d~ciaration of D~m~c~te and Gtizenship in the Sta~e of Fiorida that f am filing this day in accordance and
.n conformity w~th Chapte~ 222, Section 222.17, Floricla Statutes. '
x
_ ~::~t,Ct~-_ - - ~ ~„t .~.,;ia--- -
I was formerly a legai res~dent of _ ~
~C~ty~ (State)
and 1 resicied at L"_''~_ L ~ - ~ - - - - - However 1 have changed my domirj~a
~ (Street anci NUmber)
'o and am and have been a bona fide resident of the State of Florida since _ day of
~ _ , 19 ~C and ~ reside at _ ~f
- - -r- - ~
- (St t and Number
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and th+s statement ~s to be taken as my deciaration of citizenship, actual legai res?dence and domiule in the State of Elorida. ~
(lnsert here any pertinent fatts, such as sale of property or business, or reiinquishment of employment
at former domicile, remvyai of family to new domiule, purchase of home, etc.}
~
~
~ E p t
j fS~t~t4f
E G4U TY ~t,~.
{ ~ 'e - IlpyEa ?0 R~~ ~
~ Cl[RK C?~C~I C01iRt
RECQIIO V[RI~1 Q +L
~
~CT ZZ ~0 ~
~ 21'7652
~
- I FURTHER CER~IFY that 1 wii{ comply wiih alt other requirements of a fegal ~es~c:~ i~~s State.
1 FURTHER CERTIFY that 1 have no int2ntion to retum to my'former domi4le, and I intend to remain in FORT
~iERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~~"?;~`~u j ~f'.L1CNS
" ~
~A.
- _ • (Name)
_ i, - n .
y~'~ ~ y,~ ~ • Y`'~~. . 4 ~
_ _ , + h , ;
- ~ •y L ,a,~~,~~' _ ~ ( re ~.I~~
- ~ ~ . ; ~ : . r ~ , ~
rn d~. ,`cl~bed before me this day ot 19~'
~ Svcrc ; i9..dn ~s~, .
- ROG~R ~O1TRA5
ClE K IRCUIT COURT Notary Public
' ~ i -
a f~ p.C, My Commission exp~res
~ (To be executed in duplicate and original filed with Cle~k Gircuit Caurt, and duplicate with ?ax Assesso~.l
= a~~K 1~ 1745
'3 p -
_