HomeMy WebLinkAbout1278 = Daclsration of Domicila and Citizenship
TO THE STATE AND COUNTY TAX A5SESSOR, -Li,~~~~'~ ~
Sl. 111C1E COtlNTY, FIORIDA:
This is my declaratinn of `Domicile and Citizenship in the State of Florida ttiat I am filing this day in accardance and
in conformity with Chapter 222, 5ectia~ 222.17, Florida 5tatutes.
~ _ Bastoa
I was formerly a legat resident of _ _ -~ptq.R~-
(City) ~ (State)
and I residec! at ____B~X 242 StOCk!'itOMp _ . However 1 have changed my domicjle
' (Street and Number)
to and am and have been a bona fide resident of the State of Florida since ZIId_ day of
JUrIt-- . 19 65., and i reside at .__-____$~~1Z~1~,?t Asrp
~ (Stre~t and Number)
FORT PI~RC~, SAlNT IUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of ~lorida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domitila, removal of family to new domicile, purchase of home, etc.)
~stablishing r~sidency
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Bntering rhild in school CJ81 _~~~EI7
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uT. L~Cl~ ~:,z~ Czt~R~{
fiIOR paU~JTY.
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1 FURTiiER CERTIFY that I will comply with all other requirements of a legal residet~t pf,?11~.~tata~ .
. . ~
. -
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= FURTHER GERTIFY that I have no intention to return to my former domi4ile, and 1 intendr4b°°tei'riain.in FORT
PIERCE, SAINT LUCIt COUNTY, FLORIDA, permanently.
. ~ . i-; !f, , -
. . (Name)
- . ~ Dolores Noble
. Jr (Address)
''.;~~r. ~ ti-
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'~~~'~'r~•Sworrl'~to and subscribed before me this ~9th_- day of - , ust ~ ~q 65
;
ltOGER POITItAS - -
K CIRCiJlT COURT Natary Public
- D.C. My Commission expires
(To b~r ~x~cut~ €n duplis~ts and oriqi~al ~iied with Cl~rri~ Circuit Cou~t, and dupliuh with Tax Assesst~r.)
~aaK 125 ~77 f
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