HomeMy WebLinkAbout1274 Dacluration of Domicile and Citizanship L~c~Sfi(1
t0 THE STATE AND COUNTY TAX A55ESSOR,
51. LUCIE COUNTY, FLORtDA:
This is my declaration 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 5tatutes.
I was formerly a legal resident of . _ New_AYb~l11~! I d1 a
_ _ - - - _ ~~~P
(City) t5tate)
and I resided at 135 OJivBAVe . However I have changed my domiCile
- - - - -
~ -
{Street and Number)
to and am and have been a bona fide resident of the State of Florida since _--15th- - day of
1605 Havana Ave.
~
-----------Q-GLCbE~ 19.(~ and I resi e at
(Street and Number)
~OR7 PlERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of emplayment
at former domiciie, removal of family to new domiciie, p~~chase of home, etc.)
Entering daughter in school
FIC '~~1_I~~a00K
, : .
- ,L ~act~.1~
~65 nr ~ v FU'1 J. 22
-i_. ' .
_ _ . - _ _1_3~3~E~t)
i 't;t.:.> C'
' '.v ROGE~ F~;. - ~.~RK
. ` ' ST. LI~CtF COUhTY,
•~~,G••.,t; • FLORI~A
~
.,ti;
t FURTHER CERTIFY that ( will comply with all other requirements of ~ legal resident of ihis State.
I FURI'HER CERTIFY that 1 have na intention to return to my former domi~ile, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE CQUNTY, FLORIDA, permanently.
. ~~,~oQ~
• . . ~ (Name)
:7 - Mrs. ~arr~s Hurst
i ' ' •ci
~ . '
~ f~ . (Address)
~ ~ . 'C~''~tti'
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~~~9wtltti~tb and subscribed before me this lg~h _ day of --~tober , 19~.~.
ROGER POITRAS
K CIRCU T COURT Notary Public
c^ ~/~c[~ mmission ex ires
~.C. My C~ ~
. (Ta b~t sx~uMd in elupiitata snd ariginal ~iled with Clerk Circuit Gwrf, s~d duplicaN with Tax Ass~ra~t'.) '
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