HomeMy WebLinkAbout1078o.~.
ho~x ~°~ ~~tc~~.~
C~claratian Qf L7s~mirile and ~itize~,
TO THE STATE: AND COUI\ i"Y TAX ASSESSOR.
' 3T. LUCIE COUNTY, FLORIDA:
fihis is my declaration of Domicile and Citizenship in the State of Flor!dn that I am iilin~ this day In accordance
and in conformity with Chapter 271, Section 222.17, Florida Statutes,
I was formerly a legal resident of N e s Y 0 rk V i t y R• Y;
[City) State
and I resided at 470 ROUte 111 S:uit~itOrvn However, I have chanced my domicile
' [Street and Nurnbsr]
to and am and have been a bona lido resident of the State o! Florida since 1St day o!
September ___~ 19 62 ana I reside at 762 Oak Street, River Pk
' [Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA,
and this statement is to be taken as my dec?sration of ciilienshIp; actual legal resider:e and domicile in the State of Florida.
[Insert here any pertinent facts, such as sale of property or busUiess, or relinquishment of employment
at forme: domicile, removal of family to new domicile, purchase of home, etc•]
Estzablishing residency
110~U5
. ..,,::. ~ iciai R~or-O- 800K
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- . .. : ,~ .- , ,. .. 1961 NOV 23
.. ` ~ ~~ .~. , ~ ~ ROGER POITRAS. CLERK
' ' ~ 'F " ~`':' ` ~' ~~: Sj, LUCIE COUNTY, f LORIOA
I FURTHER CERTIFY that I will register at my local address when the registration backs reopen, and comply
with all other requirements o± a legal resident of this State.
I FURTHEP. CFRTIFX that I have no intention to return to n:y former domicile, and I inten9 to remain in
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~ ..,.`-
Fr®d ~. ~ ~-s ~~"Iie I~eaers
[Address]
Sworn to and subscribed before me th1~ 3rd lay of ~ .~~vetilber ----, is 62
ROGL7t POITRA$ ' : ,-~s w„ 3:
CZERIt CIR 1T COURT ', i < <~ ~ ~ ,¢. ~ << Nataxy P!~bl#c
~_~..~_
~ , ~,,'-' 7'.
[To be execute~ii in duplicate and ~ri*isal t11ed with Cltrk=._~'" ats+~~ituplicate w.lt3 Tax Asseat~nr]
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