HomeMy WebLinkAbout0248Declaration of Domicile and Citizenship
TO T1iF: STATE AND COZ7NTY TA\ ASSESS(~~K 4y YAGE~4~
~T. LLICIE: COi?tiTY, FLORIDA: ST. ~ ~!~!(_ ~~~'h, Y, ~ i ti•
This is my declaration of Domicile and Citizenship In the State of Florida thet t am filing this day in accordance
and in conformity with Chapter 222, Sectior. 222.1-7, Florida Statutes.
Louise illa Kentue ky
I was formerly a legal resident of - - -- --•
(City] Statc+•
and I resided at___ 9c~:?7 ~ JS~~~=+Veriue_ ____ however, I have chAhged my domicile
(Strew and Number] ,
to and am and have been a bona fide resident of the State of Florid: since •1th ~ day o1
Dov em~er 62 2207 r~arbare~ :+verue
_ _-_, 19--, and I reside at -------
- (Street and Number]
FURT PIERCE, SAI!~'T LUCIE COUNTY, FL02IDA,
ar.d this statement is to be taken as my declaration of citizenship, actual legal residence and do aicile in the State of Florida.
(Insert here any pertinent facts. such as s11e of property or business, or relinquishment of employment
at forma domicile, removal of family to new domicile p:rchase of home, etc•] '
1:,:.terin„ ~:ar.s ;uel+t::er sre~,or;r in the t3t:1 gr_:de of school.
I... -
- -
~~.:
i -
• ..... ~\ ~r~
~~ ~~ O
FI ~p.AFJ~ REC RDE
IH ~~1LI~l ~~~i 600K
1962 NOV -5 AM 8:51
ROGER PO`TRA~. CI~RK
$? . IUCIE COUP ~ E 4p X10 A
I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and comply
with all other requirements of a legal resident of this State.
I FURTIiER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
FORT P)tF~.ItCE, SAINT LiJCIr COUNTY, FLORIDA, permanently.
_~iiu;
• i ~
= ~ ,'~~~... (birs. Georg ~Yl} e ~ ~
•,~--~
~' ~ (Address]
Svt•orn to and st!bscribed before me this 5th -3ay of I~foy?mber _ Is_~--
RocER l~orrRas
CZEP.IC CIRCUIT COURT
3y
19~
C
- --- -- - ---IvTotary rublic
Diy Commission erpi
[To be executed la ~lupllcate and original f11ed with Clerk i^,Ircult Court, and uupl(cata with Tax Aa=~-..sor]