HomeMy WebLinkAbout1649BCPK ~~ PAGF~~~
Declaration of L~~lixlicile ®nd Citizenship
ST, IU~IE COUNTY. F~A.~ .
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TO T:iE ~ i ATE AND COUNTY TAX ASSESSOR,
3T. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile knd Citizenship in the State of Flo; Ida that I am filing this day In accordance
and In conformity with Chapter ?22, Section 222.17, Florida Statutes.
I was former:y a legal resident of_ Unign,
[City]
New Jersey
State
and I resided at 10~ Mount ~ernOn Road _. 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 14th day of
Ncl_vemtZsr _, 1s 62 and I reside at 205 Olive Ave. _
[Street and Number]
FORT PIERCE, SAINT LUCIE COUNTY. FLORIDA,
and this.staterent is to be taken as my declaration o[ citizenship, ar.t:~al legal residence anal donicile in the State of Florida.
[Insert here any pertine~~t facts, such as sale of property or business, or relinquishment of employment
at forn:er domicile, removal of family to new domicile purchase of home, eto)
Ss~ablishing residence
1~-~9~1
FILE ~~ ~~9~~~~
IS61 DEC -~ AM g 5 ~
R06ER B~i~~QS, CLERK
St. LU~If G U. Y; FL~ORtOA
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1- ~ - ,
I FURTHER CERTIFY that I will register at my local address when the registration b~olc5's~~e~t;)at~df%compiy
with all other requirements of a legal resident of this State.
I FUP.THEP. CERTIFY that I have no intention to return -to my former domicile, and I intend to remain in
FORT i'IERCE, SAINT LUCIE. COUNTY, FLORIDA, permanently.
~~ ~, ~~
hrs. Edna F. g£~aDe]
205 Olive Ave.Ft.Pierce, Florida
- (AldressJ
5worn„to end:)rubscribed before me this 5th gay of DBCember __~ lg~
_ ..•' ~.
a) •'•~ Cj•~R_TC CIRCtiIT COURT Notary Public
..~ U3y>~ - ~ ~ ~_ D.C. ri1y Commission expires
" ~' J ,~;
• • Z •~('~a~6e executed in duplicate and original tiled with Clerk Circuit Court, and duplicate ~vfth Tax Assessor]