HomeMy WebLinkAbout0861 l~urm l:. '1'. t'-GUi-ll-(-1U~1-i-IU-bb)
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D~~lar+~~ion ~f Domicile ar~d ~it~izer~s~ip ~
TO THE S1'A'1'E ANll COUNTl' `1'AX ASSESSOR, 1~"~
_ Luci~ COUI~TTY, FLORIDA :
'i'his is my declar~tion of Domicile ~nd Citizenship in the State of 1~'lorida that I~m fiiing this day in
accordance, and iii conformity ~vith Cht~pter 222, Seetion 222.1~, Florida Stxtutes.
I was formerly ~ legal resident of_._________ Portlana Ore~on
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( City ) ( StAte)
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- ' ..t.v ~ _a. ~ a_s~ vaa siv ..iZuc. ~ - ' ~
all(~ 1 1'C31(~eC~ ~1L.__.-~ - - - . nujVeV~F, i tiKtic i:ii~iii~~u i~j3 uGiiil~tT~ :
( Street and Number) -
tu and am and h~~•e beei~ 3 b011A fide resid~nt of the State of Florida since._.__th~__3Q~1___________._____d~y of
Dece~mber 195~--- , and I reside at---121.-1. _t~~orrut~~siaP_ Bo~.ev_~a----------- - _ :
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(Street and Number)
Port St. Lucie St. I,ucie _ _ _________County, Florida, `
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(Gity)
and this st~tement is to Ue taken as mv declaration of citizenship, actual legal residence and domiciie in
the State of Florida.
(Insert here any pert.inent facts. such as sale of property or business, or relinquishment of employment at
former domicile, removal o! family to new domicile, purchase oi home, etc.)
~ I am an lfri~~ officer on active duty. I have nurchgsed the above nroperty Frith
the i~ttention of malcing i ~ rr~y nei7~ianent home unon retirement in the reasonab7y
near future.
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I FURTHEit CERTIFY that I will register at my local address `~~hen the registration books reopen,
. and comply ~~•it.h all other requirements of a legal resident of this State. `
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I FURT~~ER CERTIFY that I have no intention to return ~to my former domicile, and i intend to remain ~
` . • Port St. Lucie ----------~t..__Luci~--------------- -------------County, Florida, {
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( City) ~
permanently. ~
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LLES~III,I3N SOB~CE (Name)
Colonel, U. S. Arn~ ~
~--$27--Grazi~--Averiue~~~j Leaveri~~*ort,fi, Kansas ~
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S,wori~;ta and subscribed before me this.___4th day of ~
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. _,J;~j ;"s~,D~o ~bI'ic State oi ICansas U R ~
"J--~ -~'~•:`,~-•.z~ -~esit~.ty of Leavenworth SOOK ~
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b~Y_ (b ~n~n#ii.,.~s~'~•-exP~res-----12--Augus~__19_6_7------------- - - !
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~'ro b~ ezecuted in duplicate and original filed R~th Clerk Circuit Court, and duplicate ~vith Taz Aaaeasor)
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