HomeMy WebLinkAbout1648Declaration of I3ol7iicile and L.rtlzena}><l~
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30 THE S'!'ATE ANJ COUNTY TAX ASSESSOR,
ST, ~UCIE CuUIlTY. ALA.'
3'r•, LL'CIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the Stgtc 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 AtlBnt.~ ~ - GeoICBSt~i -
(f~lty] State
13101 De SOtO AVe. - S~'No IIowever, I have changed my domicile
and I resided at v
[street and Number] 19
to and am and have been a bona fide resident of the State of Florida since
TV O V 9ffib 6r ,__ lg_ ~ and I reside at --
day o! y
424 N. 4th Street
[Street and Number]
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA, ~ V `_,
and this statement is to be taken as my declaration of citizenship, actual legaLresidence and domicile :n tie State of Florida.
[Insert here any pertinent facts, such a~ sale o[ property or business, or relinquishment of employment
at former domicile, removal of family to new domicile. purchase of home, etc•]
s
F.Iltering '~lillaim L:;-rry Andrews in 11th Grade
" Richard Lee Andrews in 10th Grade
" Donna Bischoff ts.>t~t in 7 th Grade
~ Nina Bischoff in 5th Grade
1~-~9%~0
I•ILED AND~iECO~DED
IN ' ' ~_.-~' _BOQK
1962 QEC -5 AM 9:31
SR.I U~IE COUNRA ~IOR DA
A
_ :t--
..,,..
- _ ~`UR~. CERTIFY that I will register at my local address when the registration books reopen, and comply
wily ~af1,`b~her.r~,gihents of a legal resident of this State.
. ,r'.,UUIt vG ~.
:{•. ',~'lsc~'t}it'IiI:E,'F'.F3TIFY that I have no intention to return to my former domicile, and I intend to remain in
- d 1 '.
p'Q~~' -~~~, ~-I;t7CIE COUNTI', FLORIDA, permanently. ~/ ~I - ~ /
- ;~~~i ' ~
.~; ~~ • ~ :a~.'_;%,: 'i^ '~•. [Name]
- ~.~'%~ . \\ - X Willia~! A, Andrews _
[Address]'
' F
Sworn to any. subscribed before me this `~ iay of
ROGER POITRAS
CLERK CI I.LIT COURT
3y
Deoemoer __' lg~ _
i Notary Public
~iy Commission e~cpires
[To be executed in duplicate and original :fled with C:ierk Dircuit Court, and duplicate :vith Tas Aasessor~
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