HomeMy WebLinkAbout1536$fW A
T ~ ~i ;IiN~r, RA.
Declaration of Domicile and Citisert~'~~~'
TU THE STATE ANll COUNTY ~AX ASSESSOR. .
~ i nt .,,~ i A COUNTY. FIA~tIDA
lfiis is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in
accordance, attd in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of Cordele __, - ---_ Ga •
;~ E;: iRsl~)
and I resided at 620 15th ~S~e, EeSI; - However, I have changed my domicile
(Street and Number)
n,.:, .. „, ~„,~ h.,t•P l.~rn a bona fide resident of the State of Florida since 2G day of
June 19 60, a::d I reside .:t 104 Gardenia Ave.2 _
(Street and Number)
FQrtPierC-e__ _ St ,Lucie _- .County, Florida,
(city) -- - - - - -
and this statement is to be taken as my declaration of Citizenship, actual legal residence and domicile in
the State of Florida. y
former domic l~eY remo al11of fsmily to new domicile purchase of b ~~, ~~;l,nquiahment of employment st
Entered U. ofFla. in August 1958 until 1959 in June
June 1°5y to June 60 in Clearwater, Florida. '
Replication forHomestead
c~~ ~n ~ m ~Fr~^~lt:
i !~._.. ~t__ .. _:.... i
-"` L ~,
r' ~'
l; POtTt;~,:.. ~~;
. V. .~ ~~`„1i.~ __
. ~-~__ _ .
' - ,
i FURTHER CERTIFY that I will register at my local address when the registration books reopen, .
e t......1 .. '.,n„+ of thir. Ct:,tP,
and comply with ail other requirerneilts o. a ,=8u= =cst-...•-~
I FURTHER CERTIFY that I ha~•e no intention to return to my former domicile, and I intend to remain
Fort Piel'ce St.Lucie _County, F]orida,
in --
-•
(City )
permanently. _ -- _ _ ._ _
_ - p-----
Jerr~r A.- jint?t?rame)
----
- -- _ - -(Address)
Sworn to and subscribed before me this. Ord day of _ ~.t ; ' .
' : ~'
...
Fab. - - - -. A.•D. 19_.sl.
.• .. •~
/~ ,_ , .i~-c ,~ ~~ -~~. - -
- - Notary Publie State of Florida at I,arye ~ ~'
My Commission expires-_ Jan-- 15.1 __1964_._ _-____________
ITo be executed in duplicate and original filed with Clerk Circuit Court, and duplicate with Tax Assessor)
d