HomeMy WebLinkAbout2528 ~ , . . . . _ . . _ >
~
~ Declar~tion of D~mlcii~ ~rrd Citizereship ~~1~~0
1
~
; t0 THE SYATE AND COUNTY TAX ASSESSOR,
~ ST. IUCIE COUNTY, FLORIDA: ' . ,
1
? This is my dectaration of Domicile and Citizenship !n the State of Florida that 1 am filing thla day tn accordante a~ci
~ . . ~
~ in conformity with Chepter 222, Section 222.17', Florida Stat s. _
~ -
~
} ~~S % ' 01~1 C ~ tl~.v,~ -s -
I was formeriy a legal resident of
~ • , . (City) (State)
~ and I tesided at ~L'~ ' . Hawever 1 heva chan ed m doml i
~ ~u. g y d e
~ (Street and Number~ ~
. .Lf~
ro and em nd hava been a bona fide resident of the State of Florida since day of
~ ~
! • • ~ .
~ ~ . ~ ~ ~ ~ , 19
;~L, and I reside at ~d ~ ~ ~ h ~ ~/r ~~~d ,
; ~ (Sireet and Number)
~ . - • !
` FORT PiERCE, SAINT LUClE COUNTY, FLORIDA '
and this atatement is to be taken:
~s my declaration of citizenshiR, actual fegal residence and domicite in the Stata of Florida.
j; (Insert here any pertinent facts, such as.sale of property or bustness, or ~elinquishment af employment
~ at former domicils, removal of family to nsw domicile, purchase of hoi-ne, etc.)
~ ~ .
~ - ' ~
r. ~
~ . f k
~ ~C~~ ' . ~
~`S J ~4b ~.~s ri ~
. .
° ~ 1.3~..~~~ ~ .
` • o~
~ ~ ~ ~ ~ I.ED ANO R~CO ~E~ ~ ~ .
, FI ~ BOOK ~
' ~ ~
, ` ~ . - IN ~
i : . t ~
. - • 9 _ ~4~'~'''~~ . " ' ~ .
. ' .
:j _ t964 DEC 29 PM 2• ~ , . : r
• ~...~r '
~ , - ~
' RpGER P01`~RAS.CIER ~ •..~~e3::~+:~• i~r'
, - gt. lUC1E COt1Nt`(. FlOR10A f~ ~l~,
~ _ . ' . .
- _ . .
i _ ~ ~
~ . ~ f .
• . . . i
~ ' . ~ ' . . ' . - . . . -
. ~ i FURTHER C£~1tTIFY thet I wil) comply with ali other requlrements of e(oga! rosid~nt af tfits Stata. _
r - i FUR~HER CERTlFY Yhnf ! have np intention to return to my former domt~ile, and i intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY~ fIORI~A, petrr~anentty..
j
r~,.~ • v'~ ~~G~~ t
,
, . . - ~
4 s • ~ * . ~ ' (Nams) •
_ ~i~l~~~^'' _ rj~.I', ~ . ,
. ~~:j i' f i ~ f' ~ ~ ~ . . - - . . F
~ _ . ~ • { /~.4~.1 _ _ _ `t t
a
~ ' f t'1 ~ ~ ~ ~ G~'" . p '~j ~ . ;
F i~~~~~'~~~ ~ . ; ; . . t
. ~ .,t ~ r.
~t ~ ~ (Addreas) . ~
. , , ~
: t~a.....•~~ , .
Sworn to and :uburibed before me this ~ day of , ~q
~ ' . . . - ' ' . . L ~ ' . .
'1 R~~~ ~~~s , ' • , ' f
CIERK CWT COURT Notary Public
~i ~ _ , i
r ~Y ~ D.C. ~ My Commission exptres . ~
:i ~ .
; . , _ _
; _ _
;i ~
't ~ Cfo b~ ~x~cut~d in dupliuto and ~i~inal f~i~ . with Ct~ric Gccwh Court, snd duplieah wifh Tax Ass~sora
u.
~ ~ . BU~x ~.07 ~~~,~,f-~.2? ~
~ - - - ~ _ ~