HomeMy WebLinkAbout1470 _ _ , ~
Decl~ratlon of Dorrricile ~nd Citizehship ~
1~3~~;~()
TO THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE COUN7Y, FLORIDA~
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance ar?d
in tanformity with Chapter 222, Section 222.17, Florida 5tatutes.
1v0 - -
I was formerly a legaf resident of _ Gi$.tQI~18 _ i .G~IQlIri~
(C'ry> _ (State)
~ and I resided at 1022_ Maune~r AV@• : . However I have changrd my dornicjle
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since ~5tb__ day of
- M~tICh-- , 19__~ _.S,S~nd I reside at _._~Q_~t~K~~t Dr i vp
(Street and Number)
FOR1' PIERCE, SAINT LUUE COUNTY, FLORIDA
and this 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 o# property or business, or relinquishment of employment
at former domitile, removal of family to new domicile, purchase of hame, ett.)
~ntering child in school '
FI ANP RE~~~~ OQK
~t?c?a
i~a._
~R. G~~''`' ~ ; yo
~65 A1~G 2 P!~
1~~S~~~t) K
~ER ~
. , J';`'" R~S~NTY.
.~~3~,~,;i` iC~/,;~;-~ ' R~S.~ ~~y~ 0 CDOA
_ _,'y ~ r ~
J ~ f,: _
.n ti .
• - - ~ ' ~ ~
J•.. . . _ ti.
, ~ ~ •
/~~'r ~ ,
'~~%iff;:8ii11~~'~
I FURTHER CER7IFY that 1 wili camply with al! other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FOR7
PIERCE, SAINT LUCIE COUNTY, FLORIbA, permanently.
. _ . (Name)
~
-J . . Roy IN Nayberry
~ ~ ~ N.. .
' (Address)
, •
\
~ ~ , 24th Au uat 65
~=5wo:rn tb and subscribed before me this day of -_~-_-g--_- . 19----•
, ;
ROGER POITltAS - - -
K CIRCUIT C URT Notary Public
a.~t~t,~,. ~
gy D.C. h1y Commission expires -
(To bs exscuted in duplicate snd arigina) filed with Clerk Circuit Court, and dupliut~ with Ta~t Ass~ssor.)
60uK ~GiC? - -
ii