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HomeMy WebLinkAbout0510 222885 Declaratio~ ot DomiCite and Citizenship iriE ~1Ait Ati(i L~:'::~:iY ~AX Ati.~~•~~,~•~ • I . . ,~!E CO:JN? :«~R!i~~ {'i.~ jc'-~9!1' J'1 ?1 .):J"~': _ dt:;j l.•.~:ZC".SfLP in the ~:d!F J+ FiOf~:1d i~~d'. 1 0"~ f, U i~'1 i[~.1~' ;i'.:7:~d(.. .....1 li~.~.~.h~ .ti~T1: l. h.i~-i~E•' ~ ...~rr,_~ :17 ~7. F!ni~:la jt3t~~:a~c .,r.,, t P08T AASHINGTOA N. 7. ~C,sy, f~':,ret . ~ ~ . ~ 26 So. Washington St. : i~:,,~~ ~-,.j~,::~.: ~ ~ (Street anci Numt~~e~ ~ . ~~.ci a-~c1 !~~~r :~ec~•, r. criv f~de resi:~ent of the Jfate of ~fon:~.~ s~rcr 12t~1 i.~.; ;,f DeceEber ~9 71 ~n~ , ~~S~~z 175 Bonita Ct. , ~'t. Pierce, ~'l. (Jfre~t d:~'~ T~1U-~lL~~~~ FORT PIERCE, SAINT lUCIE COUNTY, FLORIDA ~ l ~ . . .'3'_ :s h~. , i~.e,, ~S , ;~a•Id•a~~Otl ot ..t~rensh~p, a:.tual feg3' +e~,cje~ ie a•'.:~,~o•, ~ :e :r, C~.;?~ nf . :a ~ (~~;~rr hn.~ .9~~y r~ . ,?c:, f:]~t~, ,~:h ~S s,i~e ~f prope~lY O~ U:;i~~1~55. Or _ ..C~:.~~~,.. ~1 P' , '~v- ~E• ~t t~r^~er do...,ci c~. ~e~•'~.a: of *.3 :y to ~ew d~^~ici!e. ~~ur.!tase of h~me. e~c.l RESIDEACE 222585 - /ILEO AH: ~`CJRDE~ S?.LUCIE C!~: `T~AS`A ~ ~ A~GE~^:;~~T COU ' ; I CLE~K ~,',~;ct~ REG i f R ~ Z~ 9 4s AN'ZZ ~ _ ~ ; ~ ~ S ~ 3 ~ 3 ~ t ~ ~ 1 r ._t FURTHER CERTIFY ihat 1 will comply with ail oth.er requ~remems of a,egai re_~de. t of ti~~s 5 d e. ~i ' ~ ~ ~ 1 Fi~RT-iER CERTIrY tr~at f h~~ve r,;, ~nser,!;on to retum !o r;y for•- er ,:o~ ,,`e, a~,c? I,.,t: d!o r~•r~:_„ ~ ~JRT ~ _~CE. .;A!NT lti"_iE C~-~J~~~TY, ~ LGRlUA. pern~aner,tiy ~ - - c~L~~ GEORGE D[ACKEY _ ~i (Ndr•'.e` ~ ~s ~ - 175 DonitnCt., l~t. pierce,~'1. . . . ~a~-~->>>.± 33450 ~ . " $wOrn to and s~bsc:,oed befGre me th~s 28th rJay o4 J821u8T~ ? G 72 ~ . RbGFJt.po~r~u3 , CLERK CI~tC1~1T~~COURT r~~r~-y : ~ ~ a .d1-~ : -~,y U.C My Commi;s~on ex.p;res { - , f ~ . s _ _ _ _ . . _ _ _ _ . . . ~ = (To be executed in duplicate and original filed with Clerk Circuit Court, and duplicate with Tax Assessor.) ? _ F - ~ ~~RK199 PAr,E 5 . 09 ; _ ' . . . _ ~ P . ~Y