HomeMy WebLinkAbout1597 ~eclaration of Da~nicile and Citizenship
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TO THE 5TATE AND COUMTY TAX ASSESSOR, ,
Sl. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile an~ Citizenship in the State of ~lorida that I am filing this day in acmrdante and
in confarmity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a iegal resident of ChiCagO ~1~1TlO1:
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(City) (State)
10422 S Park Avenue However I have chan ed m domic,ile
and I resided at _ - . - - ~ 9 Y
(Street anci Nurt~ber)
22
to and am and have been a bona fide resident of the State of Florida since _ _ day of
October 6S 641i S~ Ind~ River Drive
. _ . . - - 19- - and I reside at ~ _
(Street and Number)
FORT PIERCE, 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, suth as sale of property or business, or relinquishment of employment
at former ciomicile, removal of family to new domicile, purchase of home, etc.) ~
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_ ~goo~
Entering son in llth Gr$de 'ss OCT ~
" da~~hter i.n 4th Grsde ~~5 P~J ~
~ 31
• ~ " , , ~ r~l ~ R + ~
. sr. ~ C~E~K
: ~ FlOt~paUNTY.
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I FURTHER CERTIFY that I will comply with all ather requirements of a legal resident of this State.
f FURTHER CERTIFY that I have na intention to return to my former domi~ile, and I int~nd to remain in FORT
PIERCE, SAIN7 l4JCIE COUNTY, FLORIDA, permanently.
. ~ • • - ~--~-r'_~
,
. ~ , Beverly J. Flietb
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(Address)
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Sworn to a~d subscribed before me this 2S day of ~tObCr ~ 19 6S
ROGER POITRAS - -
Ct~RK CiR IT COURT Notary Public
gy ~ D.C. My Commission expires
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(To b~ ~xecuted in duplicats and ori~insl filsd with C{erk Grcuit Cou?t, and dupiisat~ with Tax As~s~o?.)
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