HomeMy WebLinkAbout1131Declaration of L?omicile brtd Ci±ize>ZShip
o. P. 5Q ~4~7'
TO THE STATE AND COUNTY TAX ASSESSOR, B0~ X FA(
3T. LUCIE COUNTY, FLORIDA: s T. ~ ~ "'~F ~ ~~,'N~ Y, ~( ~.
This is my declaration of Damicile .and Citizenship In the State of Florida that I am filing this day in accordance
and in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of C i ne i nna t i •
[city)
Ohio
State
and I resided at 8202 IAis Drive _. 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 16 day of
Nov ember _!, 19_ 62 ana I reside at 2655 ~'ort_Pi ere a Av 9
Le~kewcod t' .rk [Street and Number]
FORT PIERCE, SALNT LUCIE COUNTY, FLORIDA,
and this statement is to be taken n~ my declaration of citizenship, actual legal residence ana domicile in the State of F1orlda.
[Insert here any pertine:~t facts, such ns sal' of property or business, or relinquishment of employment
at former domicile, remo~•al of family to nets domicile. p;:rchase of home, etc•]
Entering Mrtry Esther Meacle in 10th Grade
1.0640 _ ; ~~,~ ~.~ ` ;:,
,- ..
F'i~~t14~DED ~ ~ ',
-_ r BOOK
i i~
1962 NOV 26 AM 9: ~-2 '~ ~-•~~• ~ ~ ~ ~=• ~ ~'- •~ '
t ., ..
:,,~, , •~
ROGER t'OITRAS, CLERK •~ ~-;'•,~;•;:;'~~:~"'. ~~
S1. LUCIE COUNTY, fIORIDA
a~.
c ; . ....
~~'
.,
I FURTHER CERTIFY that I wi~l register at my local address when the registration b:oks reopen, and comply
with F11 other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no inte~ion to return-to my former domicile, and I intend to remain in
.FORT PIEI26£,,~..4~NZ~LU- ~T° p:rmanently.
/Florida / ~~~~~~8
[Name)
yeroge "`eade
Sworn to and subscribed Before me this 2 6
[Address)
Say of Nav eAlber ~ is 62
P,OGER POTI'R.~S
~`LE:RK TRCUIT COL'R'T
~y _ ~.~~.~ ____
___ n.c.
Notary Public
`.Iy Co:mission expires
[To be c.YCCUted In duplicate and original tile•i with Clerir Circuit Court, acrd duplicate with Tax Asse.~sof]