HomeMy WebLinkAbout0966 f~arclaration ot Damicile and Citizsnship
13`7~'70
TO THE SYATE AND COUNYY `AX ASSESSOR, ~
Sl: LUC1E COUNTY, FLORiL~j1:
This is my decla~ation of Domicile and Citirenship in the 5tate of Fiorida that I em filing this day in aceardance and
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in conformity with Ch~pter 222, Settion 222.17, Flo~ida 5tatutes. `
I was formerly a legal resident of .g~1$L~F~.~____~_-___-- _ Georgi~
(Cityj (State)
1445 RidgeMood Dr -
and 1 resided at _ , - _ . However I have changed my domicjte
(Street and Number)
to and am and have been a bo~a f+de resident of the State of Fforida sinte l~t day of ;
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, 19~_, and I reside at ~~Q~
G'eOrg_ia Ave.
- ----Jltl~------- (srr~er And ?Jurr,ber)
FORT PiERCE, SAiNT LUCfE COUNTY, ~IORIDA
and ihis statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of properfy or business, or relinquishmtnt of employment
at former dornicile, removal of family to new domicite, purchase of home, etc.)
, ~ntering ehildree in scho6l
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I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of fihis Sfate.
I FURTH~R C~RTIFY that f have no intention to return to my former dom+~ile, and I intend to remain in FORT
PIcRCE, S~IN+~,~~~E, COUNTY, FIORIDA, permanently.
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~',.t f ~.;~~'i,^a ~vs ~J. (Name)
- ~Mrs. wm Carter
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Sworn to and subscribed before me this llth d~y of AVguSt ~~9 b~
ItOGER POITRAS - - -
K CIRClN~' OUR~ Notary Public
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B - - - D.C. My Commission expires
(To br? ~xircuhd ir~ duplicate s»d ariginal filad with Clerk Grcuit Court, and eiuplicst~ with Yax Ats~ar.)
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