HomeMy WebLinkAbout1518UDrcK ~_l. I A:r.1.~~i
Declaration o S ~?Q~~u c~hzen~hip
TO THE: STATE AND COUN'T`Y TAX ASS~S~)R.
3T. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile 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.
Powell --- 1-~°-wing
I was formerly a legal resident of [City] ~ State
and I resided at at 3 r trout B Ho~~•ever, I have changed my dorni~~le
[Street and Numbed
13th
to and am and have been a bona fide resident of the State of Florida since ~~~~' - day of
fiovember _ .ls 62 and I reside ac _
[Street and Number]
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA,
and this statement is to be taken as my declaration of citizenship, actual legal residence anal domicile in the State of Florida.
[Insert here any pertinent facts. such as sale of property or business, or relinqushment of employment
at former domicile, remo~•al of family to ne~v domicile. purchase of home, etc•]
Entering GTOe Curtis Biker in the 3rd Grade.
'dill be buying property soon.
1~.Q8~~6 .. _
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1561D~C-3 AM 11: 58
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:
ROGER POITRAS, CLERK _
~ - °j•tT%.~n~~
~/
ST. LUCIE COUNTY. FLORIDA -t~~~,;,~
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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 1 intend to remain in
FORT PIERCE, SAII~'T LUCIE COUNTY, FLORIDA, permanently.
~~ ; ~r ~ J Ly B~ k [Name]
' '`'' 1 ` '~ ;, .. = Dorothy Ba ess]
. ; :.- „_ -
~- ~ bad.betore me :h.:4 26th Say of November 19 ~2
Sw~ortf' 4o and 'alii~si~rl
., ~~p~'p~...g_ r
CLERK CIRCUIT COURT Notary Public
3y D.C. My Commission e.~cpires --
[To be e~gs.;vted to duplicate and original filr,~i with Cicrk Gtrcuit (~nrt, end duplicate with Tax Asvessor]