HomeMy WebLinkAbout0136 - ~ _ _ _ _ _ _
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Declmration ot ~miclle and ~itisenship '
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TO TNE STATE AND COUNTY TAX A5SESSOR, 13~;:~~ ~_1 ~
51. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
in corsformity with Chapter ~22, 5ection 222.17, F~orida Statutes.
I was formerly a legal residant of ____~C~.bidtll~__ G~ n~np
(City) (State)
U S AirForce HOSl~lti~ A~ 220 However 1 have chan ed m domiCile
and 1 resided at _ - - _ - 9 Y
(Street ent# Number)
to and am and have been a bona fide resident of the State nf Florida since _~.th day of
Septesber__ ~q
~i5 , e„d i resic~e ar __So Ocean Drive~ John'_MtCart~ H_ouse
5 f (Street and Number)
FORT PIERCE, SAINT LUCIE COUNYY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domiciie in the 5tate of Florida.
(Insart here any pertinent facts, such as sele of property or business, or relinquishment of employme~t
at forme~ domicile, removal of family to new domicile, purchase af home, etc.)
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Entering children in school'
FILEO AND RECOROED
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''v ROGER PUi i RAS. CL
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FLORlOA
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1 FURTHER ~ERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have,no int~ntion to return to my former domic,ile, and I intend to remain in FORT
PIERCE„SAlN1'~L13~lF COUfdTY, FLORlDA, permanentfy.
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Sworn'to and subscribed before me this 2~ day of - $~PtCmber ~q 65 _
ROGER POiTRAS -
CIRCUIT C T Notary Public
~y~. _ D.C. My Commission expires
(To be ~x~c~t~d in duplic~t~ and o~Qina) fiied with Ci~ric Circuk Ctwrt, and duplisat~ w3th Tax A~w.)
i 600K ~w '
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