HomeMy WebLinkAbout0664Declal:stion of Domicile and (;itizengllip
BD~k 49 FA~E~~~
TO THE STATE AND COU*ITY TAX ASyLSSOR, ~,,.-
3T. LUCIE COUNTY. FLORIDA --••
This is my declaration of I}omicile and (.`itizes~hip izy the State of Florida that I am filling this day In accordance
and in conformity with Chapter 222, Section 222.17, Florida Statutes.
Dayton mOhio ~.
I was formerly a legal resident o~ -ICity] ~ State
3448 V+111 However, I have changed my domicile
and I rasided at
(Street and Number]
8 day of
to and am and Dave been a bou fide resident of the State o! Florida since
N ov acnb er 19 62 and I reside. at S14 5 . 4th Street
(Street and Nwnber]
6'ORT PIERCE, SAINT LUCIE COUNTY, FLORIDA,
and this statement is to be taken as my declaration of citizenship, actual legal residence an3 domicile in the' State of Florida.
(Insert here any pertinent facts. such as sale of property or business, or relinqu:-hment of employment
at former domicile, removal of family to new domicile purchase of home, ete•]
ynt„ring Li;,dsl Joyae Allen in 9th Grade
Debra Jean tillein in 4th Grade
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FIlEO AND RECO O800K
IR
1961 NOV i 4 QM 15~ 53
ROGER COU RY f~LOhl~p.~
St .LUCIE. - ~.1~~ :-
I FURTHER CERTIFY that I will register at my local address when the registration bcoks reopen, and comply
with ail other requirem~ts of a legal resident of this Slate.
.t"" . e ..qtr .
,: • ~~~T t~RTIFY •,hat I have no Lntention to return to my former domicile, and I intend to rem
P'-~~ s COUNTY. FLORIDA, permanently. "
-~ r
IdUCIE /~ / ,
~'~ " ~ _ [Name]
_ cw _ ~ '
~•"~,~ _: _ -` - Mrs. Lucille Allen
, ... ~ [Address]
• `~ y'''.' a2
14 Nov ember _..__~ is
fay of
Sworn to and subscribed before me this
ROGER POITPAS Nctaiy Public
CLERIC LRCUIT COURT
!`_t~ My Commission expires-
D.C.
3y
(To ba execattd !n dapllc~te sad o°risirsl filled witk Citsia Ctrcnlt Court, anal dipltcate with Tax Assessor(