HomeMy WebLinkAbout1604 _ _ _ _ -
Declaration ot Domicile and Citlzenshlp ~
TO THE STATE AN17 COUNTY TAX ASSESSOR, ^ t`
~
Sl. LUCIE COUNTY, FLORIDA:
This is my declaratinn of Domicile an~ Citizenship in the State of Florida that I am filing this day in accordante and
in conformity with Chapter 222, Scction 222.17, Florida Statutes.
1 was formerly a legal ~esident ~f . _ _ChattiDOO~i _ . _ ~CI1D@S~e! _
~C;~~ (SteM)
and 1 resided at 240~_B•_.33~d_ Strtet___.______ _ However 1 havechanged my domicale
(5treet end Number)
ro and am and have been a bona fide resident of t~e State of Florida since _ ZQ~h_ day of
t9
65_, and I reside at 1919 l~uCker Court
- ~ ~
(Street and Number)
FQR~ PIERCE, SAiNT LUt1E COUNtY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State af Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
~ntering children in school
. F_1~~ ~ EC•
~~ED
~ . . .
: . . ~ " t $~OK
' ~ ~ r? ~ ~,tj ~ (-17 ~'1 r
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~ I.~~ ' ` • i ^ i+ 1 f v ~ i ~ j~
t~([i~~C~ ~~-~RK
`;,3~'`J,'~`,iy ~VRtDAUNTY.
I FURTHER CEitTIFY thai I will comply with all other requirements of a lega! resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domi`ile, and ( intend to remain in FOR7
PIERCE, $Rd~1T LUCIE COUNTY, FIORIbA, permanently.
~
~
~ t , . Y__~f~ c ~ 1
, - ~ (Name)
. ~ ~ Glarence 1N Satith
~ ' ~ (Address)
Sworn to and substribed bsfore n-se this ~7~h_- day of AUgUSt_ ~ 19 65
ROGER POITRAS - -
K CIRCU
T~ Notary Public
gy °''"-~'e' D.C. My Commission expires -
(To b~ ~xecuted i~ duplica/e and original tiled with Clerk Cirtuit Cou?f, and duplicafe with Tax As~rr.)
goo~ i~5 .402