HomeMy WebLinkAbout1585 ~eciaratlnn of Domiclle ~nd Citizenshlp
~
TO tHE STATE AND COUNTY TAX ASSESSOR,
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51. WCI~ COUNTY, ~L~RIDA: _e,s~~~ 3._~ ~
This is my derlaration of Domicile and Citizenship in the State of Florida that I am filing this day in acccardanca and
~ in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was fo~merly a legal resident of __.___~M _ INDIAI~IA
(City) ~ (State)
and ! resided at _ 106 W 1~[[TLBBRR~Y S"I"ZBBT , However I have changed my domicila
(Street and Number?
to and am and have been a bona fide resident of the State of ~lorida since ._14xh___ day of
____.s_____ ~~?~ust___.____________, 1q 65, and I reside at . 409_ North llth Street
(Street and Number}
FORT PiERCE, 5AfNT LUCIE COUNTY, ~LORIDA
and this statement is to be taker~ as my deciaration of citizenship, actual legal residence and domicile in the State of ~loride.
(Ins~rt here any pertinent facts, such as sale of properry or business, or relinquishment of employment
at former domicile, removal of family to new domici(e. purchese of home, etc.}
fintering chiid in schaol
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. r,' ' ORIDA
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I FURTHER CHtTIFY that I will comply with all other requirements of a legal resident of this State.
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``~;+f~;~RTIFY that 1 have no intention to retum to my former domi~ile, and I intend to remain in FOR7
_ ,
PIEREE~~=~A+Nr.l.~JC1E~ C-`.QUNTY, FLORI~A, permanently.
. . ` ' . ' ~ ~ - - ~_~G h ~-~2_~_-_
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~ , ' - Beulah Ba~~r~n
~
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- (Address)
Swom to and subscribed before me this 2'~._ day of __A ~ ~~t , 1q~~
ROQER POI'fRAS _
K CIRCUlT COURT Notary Public
g D.C. My Cammission exp~res
(To br sxeruMd in dupliate ind original filed with Clerlc Circuit Cavrt, an~i duplicsts with Tax Assessor.)
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