HomeMy WebLinkAbout0333 _ ~
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D~clarstion ot Damicile and Citizenship -
TO THE STATE AND COUNTY TAX ASSESSOR, );~~'~,',~~„'.4~
Sl. lUC1E COUNTY, Fi.ORIDA:
This is my detlaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in sccordance ~nd
in canformity with Chapter 222, S~ction 222.17, Florids Statutes.
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I was fo~merly a legal resident af ~~T~_-- -~h~.A -
(City) (State) :
arid I resided at __5~.5_P~arl Street_ However I have changed my domic.ile
(Street and Number)
~ to and am and havc been a bona fide resident of the State of Florida since .__._~4~h_.__- day of ~
' _ Se~~a~ber , and I ~es~d~ at ~a01 _BQOk@T Street
(Street and Number)
~ FORT PIER~E, SAINT LUCIE COUNTY, FLORlDA
~ and this statement is to be taken as my declaratian af citizenship, actual legal residence and damicile in the State of Plorida.
(insert here any pertinent facts, such as sale of property or business, or relinqa~ishment of emp~ox$entJ~• ~
at former domicile, removal of family to nevv domicile, purchase nf home, etc.) .
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E~t~bli~hing re~idency ~ • ~ ~ ~ .
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•yi,•.,~ . -
D[r. Isham Brown is in the ~ervice - but he is esta~liehing ,
re$idenc~ here- '
r ~?L~~a;~ OED
t+C~~~.B ~ 4 K
Children already in Elementary achool ~ere -J~~~~~~
'6~i SEP 2~ dM ~ : Sg
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ROG~~ PQITRAS, CLERK ~
~fi. ~.U~I~ COUNTY,
FLpRIDA
1 FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of tt?is State.
I FURTHER CERTIFY that I have no intention to return to my former domiule, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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, , (Name)
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~ . ~ ~ . ° ' - `:y~.- (Addressj
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. . y~::~,,;_'~
27th Beptember _,i9 65
, S~ivof~tp~~ar~d subscribed before me this day of - •
..R~fiER POITRAS _
CIRCUIT COURT Notary Public
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8 ~o-~__""`_ - a.C. My Commiss~on expires .
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(To b~ ex~cwl:d in dw~liwt~ and original ~ilyd wrth Cl~elc Ciratit Court, ~nd duplir.t» wrili~ Tax A~ss~~ssor.) ~
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