HomeMy WebLinkAbout0745C}e~clal-ation oi` Domicaile a-ic~ Citiiensllip
TO THE STATE AND COUNTY TAX ASSESSOR, BG^.~, VO PAGE 46
3T. LUCIE COUNTY, FLORIDA: S T. L U C IE C ., L h ~•~ ~ 1
This is my declaration of Domicile and Citizenship in the State of Florida that I am filinY this day in accordance
and in conformity with Chapter 222, Section 222.17, ^lorjda Statut{a~ ~~d
JOhnB jQ
I was formerly a legal nyident of- Che rle 91011 _ _ -~L.llttL~Q ral i ~
[ci:yi sate
and I resided at 223i Burr411gh8 3~ad_ However, I have changed my domicile
[Street and Number]
to and am and have been a bona fide resident of the State of Florida since ~ ~Y of
NOVembEl' 19 ~ and I reside at i6J? Ci#~rus ~+venue
•- [Street and Nti.-nber]
FORT PIERCE, SAINT I,UCIE COUNTY, FLORIDA,
and this statement is to be taken as my declaration of citizenship, actual legal residence and oomicile ir. the State of Florida.
[Insert here any pertinent facts, such as s31e of property or business, or relinquishment of employment
at former domicile, re;rt..val of family to new domicile. purchase of home, etc•]
En~ering Lynn Ferguson in 5th•Grade
c, ~,
,. ,_ .
;, ::
:,i .. .~ ~~ -~
1~_038~
(~_,~ ICIa ~~
.NOOK
1962 NGY 15 PM 12: 29
ROGER POITRa~, CtCfil(
ST. IUCIE COUNTY, FLCfiIC
~~_
f
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 TLT13fiHEF} CERTIFY that I have no intention to rQturn to my former domicile, and I intend to remain in
FORS JG~" ~AI't~'t' ~IICIE COUNTY, FLORIDA, permanently.
• ~ '~`~ ~ _ Mrs. Jessie Y, Ferguson
'~~,~ .... ``zv [Address]
., . ,~.
morn to and subscribed before me this 1~ fay of NOYembBr ~ 19 (~
ROGf:F: POITRAS
CLER IRCUIT COURT
3y ~ ~f~~
.~ __
• Notary Fubllc
D.C, My Commission expires
[To be ezecnt~ ]a daytldtte ~ arlgUnaD filtd wftli Ulerk CircutE Coiu•t, and dapilcate Aith Talc A*]
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