HomeMy WebLinkAbout1474 DeCiaration ot Domicile a~d Citizenship ~
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TO THE STATE AND COUNTY 'fAX A55ESSOR,
S'f . IUCIE COUNYY, FLORIDA:
Thia is my declaration of Domicile and Citizenship in the State of Florida that I am filing ihis day in acto~dance and
in conformity with Chapter 222, Section 222.17, Florida 5tatutes.
B or~ ling Grren Kentuck_Y ~
I was formerly a legai residcnt of _ _ _ _ . _ ry _ - -
~C; ~ (State) :
Colletedale MOtCl However I have chan ed m domiGle '
and I resided at - _ _ _ _ . 9 Y
(5treet and Number)
to and am and have been a bona fide resident of the State of Florida sin~e .___.____~'~th day of
April 65 4221 Roseland
- - - 19--- , and I reside at
(Street and Number)
FORT PIERCE, SAINY LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, a~tual legal residence and domicile in the Stete of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employmenfi
at former domicile, removal of famity to new domicile, purchase of home,; otcJ
f!!.~ .1~~ REGO~,RDEO _
Establishing sesidence ~`°~~8-p00K '
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A 'j LU~''~ n~~ ~L(.f.
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1 FURTHER CERTIFY that ! will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that 1 have no intention to return to my tormer domi4ile, and I~ntend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanenily. l
, ; , . ~ ~ ~Ca-~
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-s • / (Name)
' . . r . ~ el Ad M Harris
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Sw~drt1'~otand subscribed before me this - 21 ~ day of _ OCOtb~]C ~ 6S
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ItOC~ER POITRAS _ -
lERK CIRCUIT C RT Natary Publit
' c x-c~t~~
8y _ D.C. My Commiss~ors expirss -
~'io bs ~x~euhd in duplicate and OftglRil f1lt~ 1A/~1I1 CIOrI[ GftY1M COYM~ srad duplicah witir Tax /?ss~sw~.)
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