HomeMy WebLinkAbout1519o. ~. 5~ PD.cE 155 ..
B~~K
Declaration of L~rr~ijr~i~e ~~ YC~~enahip
• •
TO TF~ STAT1•: AND COUNTY TAX ASSESSOR,
3T. LUc'IE COUNTY, FLORIDA:
This is my declaration o! Domicile a_vd Citizenship !n the State of Florida that I am tiling this defy in accordance
and In conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident ot. Frederieksbur~ __ yir,~ir_ie
(City] State
and I resided at 30~- 29 He rr i so t1 R08 d I{ow•ever, I have changed my domicile
[Street and Number]
to and am and have bean a bona fide resident of the State of Florida since 2nd day of
Ue~e~.ber 19_62 and I reside st Ttunblin Hling i~p~
(Street and Number]
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA,
a.rd 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 a~ sale of property or business, or relinquishment of employment
at former domicile, remo~•al of family to new domicile. purchase of home, ete•]
ELtArill~g lieborah Licille iiackley in 4th grade
n iZichard Van Rodgers in the 1st grade
RECORDED
Fciai Record BOOK
I~ , -- ---
1562 DEC -3 PM I: 18
ROGER P017RAS, CLERK
$T. LUCIE COUNT. FLORIDA
~-~~e,
,.:
.. - ~ G:
' 'J' Y~;.1`, .~.
I FURTHER CERTIFY that I will register et my local address when t5c registration b^oks 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
FCRT PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~~ ` , /~~
h'us. Harney ~ .~odgei's
[Address]
Sworn to and subscribed before me this ~r-S~~ja of D8C ellber __. 19 62
•'a~y` ~.
ROGE POITRAS ~.~',~~.~~, r`-.,~_~---- -- -------------
ERIi CIRCliI COURT ~~ • • •, ~ Notary Public
i _
•. ,~-' .,
~ ~~ ~ -. ~
3y- ~;-~~.1-~- _ ~ 1?,C. ~ illy Commission expires
. ~~ _ -- s ~ ~• ~
d ~ ~.
[To be executes in duplicate and original flle3 ~•ith Clerl~ Ci~oeri't Cotart, and duplicate with Tax Assessor]
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