HomeMy WebLinkAbout0171Declaration of Dc~Inicile and Citizenship
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TO THE STATE AND COUNTY TAX ASSESSOR. 6~~'K 4~ f~~GE1
~T. LUCIE COtiNTY, FLARIDA: , ST, ,UC,IE C'~L'N i Y` FL-,•
This is my declaration o! Domicile and Citizenship in the State o[ Florida that I am filing this da}• ir, accordance
and in contormtty with Chapter 2't2, Section 222.3?, Florida Statutes.
Cleveland
I wg.4 formerly a legal resident of-_--- -
[City]
Ohia
State
and I resided at 4191 'Nest 57 t ti ~t r t? 8t ___ however, I have changed my domicile
(Street and Nu;nber]
to and am and have been a bona fide resident of the State of Florida since __~Gth day of
October `_, 19b~-, and I residr at 19?1 +lyC;IUin€j ~+uCs_
[Street and Numb°r)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA,
ar.d this statement is to be taken as m}• declaration of citizenship, actual legal residence anal domicile in the Stare o[ Florida.
(Insert here any pertine:rt facts, such as s-~lc of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile purchase of home. eta]
;,terin~ iiiciiUrd Iluuue tinderson in tii~. 1st „rode
.ts.ii~t5n
FLED AND RECORDED
iN X600:(
1961 FlO~' - i PM I : 52
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ROGER POITRAS, CLERK
ST. LUCIE COUNTY, FL~RIDA/7 ~~
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I FURTHER CERTIFY thst I will register at my local address when the registration books reope:~, and comply
with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~ `~ 7
ame]
Mrs. Arthur (~irncy) Andr;rson
Ivovec~be_r. 52
5u•orn to and subscribed before me this__ 1St_-___jay of -------------------------. 19 -
P.OG.R POITRAS - - - ----- ---- ---- --
Ci.I:RIB Cj~tCiJIT C+~UR'P *Jotar~~ Public--------
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3 . `t-c.~c~~ (petit^_d[F~L.~~ ------ D.C. r~ ~~`'~Q~m]~slon expires.-- --
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(To be executed in duplicate and origin .I file'1 wt~'.Ciarlt Cireui! Cnttrt, and duplicate with Tsx Assessor]
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