HomeMy WebLinkAbout0622 ' - - ~ - - - ~
DeClaration ot Dort~icile a~d Citizenship ~
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TO THE STATE AND COI;NTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA:
This is my dedaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a iegal resident of P1~Vlllc ~~fltUCjC~ -_~W__
- - _ _ - -
~~;ty~ (State)
and I resided at _ . B1~gS _ _ _ _ _ _ _ However I have changed my domiCile
(5treet and Number)
28 ~ da of
to anci am and I~ave been a bona fide resident of the State of Florida since Y
N _September 65 and I reside ar 110 Tuabling Kling Road_
_ _ _ _ , 19_ - - -
(Streei and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of titizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of praperty or business, ~r reiinquishment o~:e~~ioy,rjrt~t.;
: ''v • ' ~ : ,
at former domicile, removaf of famiiy to new domicile, purchase of home, etc.) ~f~~: •
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Entering childeen in 1st and 2nd grades FIL ~
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BOOK
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ROGER PptTfi45. CI.ERK~•
~T• ~.UCIE COUNTY.
FLpRIDA
I FUR7HER CERTIFY ihat I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domi~iie, and I intend to remain in FORT
PIERCE, SAINT LUCIE ~C:OUNTY, FLORIDA, permanently.
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~`r C y. i i
_ , (Name)
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~ . • . ` Eveiyn Belcher
~ , (Address) ~ -
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Sworn to and subscribed before me this ______4~___- day of -__--~tObet ~q f3S
ROGER POITRAS
CLERK UIT COURT Notary Public
gy ~ D.C. My Comrnission expires
(To be exetuted in duplicate and original filed with Cterk Circuit Court, and duplitata with Tsx Ass~ssor.j
~o~~ ~.28