HomeMy WebLinkAbout1659 Declaration ot Domicile and Citize~ship ~
TO THE STATE AN~ COUNTY TAX ASS~SSOR, j r' ~y ~
~F~ ~ ~
Sl. WCtE GOUNTY, FLORIDA:
This is rny declaration of Domicile and Citizenship in the State of Florida that I am filing this dey in accordance end
in conformity with Chapter 222, 5ection 222.17, Florida Statutes.
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I was formerly a legal resident of _ _ __GX~_tliY~l~__. _ . . _ ~ '
(City) ( ta~
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and 1 residcd at _RL __3 _~Q]C_64~. . However 1 have changed my domiSi~e ~
(Street and NumSer) ~
I
to and am and have been a bona fide resident of the State of Florida since a~Ad day of ~
~
u u-t_-- 1
--~-___A_$ _ 19~3, and I reside at ---__$Q_7_SQ_6th Street _ -
(Street and Number) ~
FORT PIE(tCE, 5AINT WCIE COUNTY, FL~3ltIDA
and this statement is to be taken as my declaration of citizenship, actval lega! residence and domicile in the 5tate of Flarida. ~
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of erviployment
at former domicile, removal of family to new domicile, purchase of home, etc.) •
B~tering chibdren in school
F~~~REC ROED
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. . ROG~;? ;-',~!"i R,'~:;. CLERK
' ~ . - ST. LUCIE COUNTY,
. Fl~QR1DA
3
I FURTHER CER7IFY that I will comply with all ~ther requirements of a legal resident of ihis State.
! FURTHER CERTIFY that ! have no intention to return to my former domi~ile, and 1 intend to remain in FORT ~
PIER~ ~~11Pl1" LUCIE COUNTY, FLOf21DA, permanently. '
;
~ ~ ~~Z~Gi-u~ t~
. :,r~ ' '~t (Name)
" ja - Mrs. Fr~ancis Clarlc
. -
~ . ~ " (Address)
, •
_ ; , .
Sworn to and subscribed before me this 27th day of _ AUgust _ ~~q b5
ROGER ~OITRAS
K CIR~UlT CaURT Notary Public
~.C. My Commission expires
(To be ox~+cuted in duplicato and original ~ilsd wHh Clerk Ci~cuit Court, and duplicat~ wiHt Yax Assestor.)
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