HomeMy WebLinkAbout0235 Declaratian of Domicile and Cilizenship ~
TO ThiE STATE AND COUNTY TAX ASSES.50R, .
.
51. IUCIE COUN7Y, FLORIDA
This is my detlaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordante and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal ~esident of NewtOn F811S. Oh10 _
i~;ty) (State)
and I resided at _ 33 ralrpOrt Str et _ Howeve~ i have changed my domiGile
(Street and Numb~r)
to and am and have been a bona fide resident of the State of F!orida since ~ tn _ day of
~~y , 19_ 65, and I reside at1817 NO Fede~al Hi~__ _
(Strcet an~ Number?
~ FORT PIERCE, SAINT LUCIE COlJNT~l, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in ihe 5tate o~ Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removai of f~mily to new domicile, purchase of home, etc.)
Establishia~. s~~~~icy
REC RpED
F11.. .~':N~ ~'~~K
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! FURTHER CERTIFY that I will compiy wifih all ot~~er requirements of a ieg~l resident of this State.
i FURTHER CERTIFY ihat I hav~ no intention ic return to rny fo~mer domi~ile, and I intend to remain ~n FORT
PIERCE, SAINT LUC.IE COUNTY, FLORIDA, permanently.
' . . . /l . ' . ~ U' l f~ Y'' _ _
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, . . (N~me) ~
• ~ JanA 1Larie :iayiett
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, . (Address)
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Sw~m to anc! subscr ibed before me this _ - - 1 ~-th_ day of --~a?~ _ _ _ 19~ 6 ~
ROGER POITRAS -
LERK CIRCUfT OURT Notary Public
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By D.C. My Commissi~n expires _
(To be executed in duplicate and original filed with Clerk Cireuit Couri, and dupl+cate with Tsx Assesso~.)
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