HomeMy WebLinkAbout0183 ~ w _ ~ _ . _ _ _ _ ~
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~ Oaclaration of Domicile and Citizenship ~
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~ TO THE STAI'E AND COUNTY TAX ASSESSOR, ~
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~ 51. LUCIE COUNTY, FIORI~A: ~
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` This is my declaration of Domicile and titizcnsfiip in the 5tat~e of Florida that I am filing this dsy in eccordancs and "
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in conformity with Chapter 222, Section 222.17, Florida Statutcs.
I was formprly a iegal ~es~denr of _port__Credit Cinidi _
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and I resided ar __??1 Lal~eshoZ't 88St However I havechanged my domiCiie .
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: ro and r~m and have been a bona fide resident of the State of Florida since ._9th day of
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_ J~1~!...._____-_ , 19
bs, and I reside at _ 113 _BtaCh Ave.. Rivtz PirY _
(Street and Number)
FORT PIERCE, SAINT LUGIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domi:.ile in the State of Fiorida.
(Intert here any pertinent facts, such as sale of property or business, or relinquishment of employment
~ at former domicile, remaval of family to new domicile, purchase of home, etc.?
Diane S1~ith, of the above sddress ia establi~hing res:ydency and
aff ir~ing that her aister, Janicr Ann Msrtin, age i5years
will be entering school in the fa11 of this year. Janice
Mn Hartin aill be in htr sister's care snd custody ~ntil the
arrival of thiex ~athtr xha is coeing doMn here to live*
~spp~toxinately the lst of Septea~ber, 1965 .
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; ~;~;,L:;. ~ FF~ RE~ ~4~A
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' _ ~ ~ ~ : ,Y '65 Jti1. 2 .
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.....:r'`f~`~ ROGE~ P~I j R~1S. CI-ERK
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"''"'`1'~FUR7HER CER?IFY that I will comply with all other re~uirements of a legal reside~~j~~~tate.
_ I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and 1 intend to remain in FORT
PIERCE, SAIf~T LUCIE COUNTY, FLORIDA, permanensly.
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- Diane Smith
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''`''rr;;:.Swotn to and subscribed be~fore ma this 23rd day of _ Jull~ , 1q 6~ '
RAGER PGITR~RS
~ ; K CIRCUIT COURT Notary Public
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~ - D.C. My Comm+ssion expires
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~ (To b~ ~x~eut~d in ~plicaro and origina! ~I~ed with C{eric Gnuit Court, and duplisst~~ with T~rx A~sor.)
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