HomeMy WebLinkAbout1213BQRiC ~O FAGE ~~~
p+~claration of rJonucil~s and Citizensthip
sr. ~i~C~~ caa~rY, rLA.
TO THE STATE AND COUNTY TAX Ag3FSSOR,
3T. LUCIE COUNTY, FLORIDA:
This is my declaration o! Domiclle and Ctti=enship la the State of Florida ttiat I am filing this day in accordance
and in conformity with Chapter 272. Section 222.17, Florida Statutes.
I was formerly a legal resident of~tney .
(City]
and I resld-d at Rt 2 _
[Street sad Number]
to and am and have been a bona fide resident of the State of F`loradg since
November
V_e rmotlt
State
However, I have changed my domicile
20th
day of
19 62 and I reside at
812 So 1 th Strt>et
[Street and Number]
FORT PIERCE, SAINT L*JCIE COUNTY, FLORIDA.
and this statement is to be taken as my declaration of citizensh Ip, actual legal residence snd domicile in the State of Florida.
[Insert here any pertirei~t facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, ete•)
Establishing residency
Entering DanielLavid in the 10th e3rade
1~.068~
.i: ° ~, ~~~ ..~
-" ;~} ,
..
~t1.E0 AHO RECOROBOOK
IN-
1962 NOV 27 pM ~fl~ 13
ROGER ~~ HTY SflORIOA
ST , l0'C«, C `,~
/~` ~,""
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 FURTHER CERTIFY that I have no intention to return .to my former domicile, and I intend to remain in
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. D
[Name]
yYilliam J. Fuller
[Address]
i,
nvorn to and subscribed before me thb 27th ~ ~., t~mber 19 62
RCG POITRAS ~~, ,.~J, a j,t."•. ),. :~•
CLERK CI CUIT COUI:T ' ' ~ ~" ~ Nutary Public
3 ~- D.Cr~~ ,," f _'daly Com~pLlslon expues -
[To be exocnted in dnpllcate and original ille:t wit2f C3(eklr airctdt Oonrt, and duplicate with Tax Assessor]