HomeMy WebLinkAbout1650Declaration of Gomirile and Citizanship B~RX ~~ FAGE2~~
•ST. LUCIE CCUNTY. fI.A.
0. .... .-
TO '1'FiF.. STATE ANl~ COUNTY TA}C ASSESSOR, ~0~
?,T. LUCIE COUNTY, FLORIDA: ST, LUCIE CCL'1VT1', ~'f -. . .
This is ~r-y declaration of Doml:ile and Citizenship In the State of Florida that I am filmy this day in accordance
and in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident o _ - -~P-~18.y1 yA i A `
y State
and I resided at 2129 B Cheletnhaln Avenue However, I have changed c-~y domicile
[Street and Number]
to and am and hava been a bona fide resident of the State of Florida since
day o1
October --, is 62 ana I inside at 317 Olive Avenue, River Par
• - [Street and Number]
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA.
and this statement is to be taken s~ my declaration of citizenship, actual legal residence an3 domicile in the State of Florida.
[Insert here any pertinent 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
l~ Q922
Jointtenancy
aNU ~ECORa~c~
IN
1961 DEC 'S AM 9:53
ROGER P pUNRY Sf lOR 0
ST, LUCIE C
•,
I FURTHER CERTIFY that I wall register at my local address when the registration b~oks reopen, and comply
with all other re~uireraents of a legal resident of this State.
I FTJA?'Y CERTIFY that I have no intention to return to my former domicile, and I intend to remain In
FOR'1;.'~~,'St~'I'. T~UCIE COUNTY, FLORIDA, permanently.
~~~ ~ _ , ~.
Sx•cil•t, tcr~titi`.~at#t :fore me this_ 5 isy of DecPm~er is
P.OGER POITFtAS
CLERI CJRCL;IT COURT -
3y tirt~ _ D.C.
Notary Public
ISiy Commission P~cpires ~ -
[To b¢ executed In duplicate and -oritiAS2 riled with CIeric iC7lrwft Court, and dnplicste Wish Tax Assessor]