HomeMy WebLinkAbout2125 Declaration of Domicile and Cit~zenship
TO THE STATE AND COUNTY TAX RSSEaSOR, 4~"~
y} . LUCIE COUN'tY, FLGRIDA
Tt7is ~s rny declarat~on of Don, c~le and Ci~,~zenship in the State of Florfcia that I am filing this day fn accc~rdance and
~n conformi?y with Chapter 222, Section 222.17, Fioric' : Statutes
i was formerly a legel residenf of N~-`~--~~~-- -
(City1 (State)
BCOC 10 Fiowever I have changed my domiGile
and I resided at -
(Street and Number)
to and am and have been a bona f+de res~dem of the State of Florida since 1 _ day ot
Nov~ber , i4_ 65and ~ reside at . 3Q~1 S._1Qt.h-.St~sat.---.------
(Street and Nurnber)
WRT PIERCE, SAINT WCIE COUNTY, FLORIDA
and this statement is to bz taken as ~ny declaration of citizenship, actuai legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale ef property or business, or re!inquishment of emplayment
at former dom~cile: remevai of family to r,ew domic~le, purchase of home, etc.)
~ Entering EZizabeth Ann Bowen in bth ~rade
, " (~ar~es ~Tood $oxen in lst (~rade
~
I
~I A D REC RDED
I ~ f~ ~_~~_Q
' • ~ _ iL1~1.1~e.G9.~a . 0 0 K
~
. -,~-~%c~~.~.~-
'65 pJO~J S, A~~ , 9 ~~13
• - ROG~~'. , `i:.`~. CLERK •
• ST. LUCIt COU~JTY,
- ~ FLORIDA
1 FURTHER CERTIFY that I will comply with all other requirements af a legal resident of this State.
i FURTHER CERTIFY that i have no int~ntion to retum to my fcrmer domi~ile, and i intend to remain ir FORT
PIERCE, SAINT LUC!E CQUPJTY, FLORIDA, permanently.
,
~ / L LG~C ~C~ '
~
~ / (Name)
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~ 3 • . ~jt7~C8 $Oji6ri
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(Address)
Sworn to and subscribed befor~ rr:` this _ day of _~~~b~r_ , 19- b5
ROGER POITRAS - - - -
LERK CiRC OURT Notary Public
'
I sY G-C. My Commission expi~es _
~ (Ta be executed in duplicate and original filed with Clerk Circuit Gou~t, and duplicat$ v~rith Tax Assessor.)
~ 6~"~1~0
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