HomeMy WebLinkAbout1680 Declaration ot Domicile and Citizenshi~ ~
TO THE 5TATE AND COUNTY TAX ASSESSdR, ~`3C~~~?~
Sl. LUCIE COUNTY, FIORIbA:
This is my declaration of Domicile and Citizenship in the State ot Florida that I am filing ihis day in attordance and
in conformity with Chapter 222, S~ction 222.17, Florida Statutes.
I was formerly a legal resident of ~LUMB~$ OHIO
- - - -
(City} (Staro)
13~4 Kelt0~1 AVC. _ 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 5tate of Florida since _ 25th _ day of
October 65 366 ohnson St.
- - - - - - - 19---, and I reside at ------=1---- -
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, fLORlDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and damicile in ihe State of Florida.
(Insert here any pertinent fac4s, such as sale of property or business, or relinquishment of employmenf
at former domicile, removal of family to new domicile, purchase of home, etc.?
ENrERING CHILD IN PUHLIC SCHOOL
GENB SMITN
,
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- ' ~'~~'~':'r " OCT 28
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, ~~~4~ ~AUNTY
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I FURTHER CERTlFY that I will comply with all other requirements of a fegal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FURT
PIERCE, SAINT LUCtE COUNTY, FLORIDA, permaneniiy.
, ~ ~
~ ; •t' _ .~r~,~ ~ ~ ~?ALR. M. ~Name) SMgTH
. ,
. .
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~ (fiddress)
4
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''••••;',~vKOrn to and s~bscribed before me this ~$th day of OCtober , i9~~.
s
R6GER POIT S
CLERK !RC T DURT Notary Public
.
By D.C. My Commission expires
(fo bs ax m dvpiiut~ and originat filyd with Clsri~c Circuit Court, and dupliuh with Tax Assis~w~.)
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