HomeMy WebLinkAbout1511 Dectaration ot Domiciie and Citis~nship ~
TO THE STATE AND C4UNTY ?AX ASSES50R, ~ 1+~ ~j `~t ~
51. LUCIE tOUNTY, FLORIDA:
This is my deelaration of Domicile and Citizenship in the State of Flarida that I am filing this day in accordance and
in conformity with Chapter 22~, Section 2~~.17, Fiorida Statutes.
` Cle~elsad Oh~o
I was formerly a legal resident of - . _ -
(City} (State)
and I resided at _ 3b60 B_103_StleCt . Nowever I have changed my domic.ile
(Street and Number)
ta and am and have been a bona #ide resident of the State of Florida since 6 _ day of
JUlq bs Route 2~o~ 2400, Js.mes Road
- 19-----, and I reside at
LakttrOOd ~~tre~t and Number)
FORT PIEIECE, SAINT LUCIE COU+NTY, FLORtDA
and this statement is to be taken as my declaration of citizenship, actual lega) resider~ce and domicile in the State of F~orida.
(lnsert here any pertinent facts, such as sa(e of pro,r.e~ r or business, or relinquishmerst of employment
at former domicile, removal of family to new domicile, purchase of home, etc.}
Bntering son in bth Grade
~IIED AND RE~~R~~~
,
. ~.~~OOK
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` 6S A~.1u 2 5 P~ 3 ~ 0 7
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'.a ~ ,y _ t~~~~± ~~j
s • RQG~h f'~fTr; ;S CLERK
:.~r 5~'. LU Y
, ~~:.'r~e~,~~" C1E COU~ET
; F~ORI~A '
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I FURTHER CERTIFY that I wiil comp~y with all other requirements of e legal resident of this State.
! FURTHER CERTIFY ±hat I have#na intention to return to my former domic,ile, and I intend to remain in FORT
PIERCE, Sf~INT LUCIE COUNTY, FtORIDA, permanently.
~ r f s~ -
+ . ~ (Name)
t ~
~ _ ~ ~ He2ene Barbiaux
_ . , (Address?
~
Swom to and subscribed before me this 25 day of ~_~~A~&us# , lq 65
ROGER POITRAS -
CLEitK RCUtT Ct~URT Notary Puhlic
, By _ D.C. My Commission 2xpires
(To be fx+~sulad in dupli~ate and originsl filed with Cla~{c Gircuit Courf, and duplicat~ with Ysx Ass~sso~.j
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