HomeMy WebLinkAbout1904 i
~;:~:araiion of L~::~ici:~ und CitiaensY~~ip
TO TtiE ~TATE AND COUNTY TAX AS~ESSOR,
Sl . LUCIE COUNTY, FIORlDA: " `
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This ~s my declarat~on of Dom~uie and Citizenship in the State of Florida that I am f~ling this day in actordance and ~
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,r~ conformity with Chapter 222, Section 222.17, Florida Statutes. ~
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I was formerly a legal residant of ` ~
(City} State)
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and I resided at ___L! ~ L Nowever I have changed my domiCjle
(Street ano Number)
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~u and am and tu~ a bona fide resident of the State of F!orida sir+~t .~22 day of
k,.~ S~ /~~I/~'~~s~i~•
_ 19~_, and i,reside at _
(Street and Number) _
FORT PIEItCE, SAlNT LUCIE COUNTY, FLORIDA '
a:,d this statement is to be taken as my dectaration of citizenship, actua! legal residence a~~ domicile in ihe State of Ftorida.
(Insert here any pertinent facts, such as saie of property or business, or relinquishment of employment
at former domicile, removal of famiiy to new domicile, purchase of home, etc.)-
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~ I FURTHER CERTIFY that t will comply with all other requirements of a(egal resident of this State.
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~ I FU~THE2 C~RTIFY that I have no intention to return to my former domic.ile, and 1 intend to remain in FORT
' ~iERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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1/ ~~~t/nc.~ ~'In~t~
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~Qn,~~'$ (Name) Ga-rKo
:r, ~ 70 5~elrna~ ~ ~~r~
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- (Address)
Sworn ro and subscribed before me this ~ day of ~ ~ ~ , 19!
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= ROGER POITRAS ~v ~
: CLERK GRCUIT COUR7 otary Public
BEMJAMIH EHRUCH j ,
~ ~ols~y Public, S.ate ot N=w Yo?k
ny O.C. sion expires k~ ;1-6~Sk~,,,~
BEH;AMi~~~ ~iitied in Q~eent Co,+w-+k., ~
Ndnry F~biic. Siate ol t~etr Yotlt
_ No. 41 • 615Y9S0 ~SSion E~pres Ma t R~ o ,~Z ~ y
- - dehf~EO in~oon~s CcK:ttY !J ~
_ (To be exvcuted in duplicate and origi~al fi(ed wit ' Kipltp.~Ai~ duplicate with Yax Assassor.) " ~
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, ~ EOOK ~90 PACf 1901,
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