HomeMy WebLinkAbout1176 ~
De~laration At Domicile and Citiz~nship ~);-;'i"~'
TO THE STATE AND CUUNTY 1AX ASSESSOR,
5i. LUCIE COUNTY, FLORIDA
This is rny deciaration or` Domicile and Citizensh~p in the State of Florida that i am filing this day in accordance and
m c~nformity with Chapter 222, Section 222.17, Florida Statutes.
Glenaha~ Penns lvania
I was formerly a legal resident of • - Y
(City) (State)
192l~ M ount A~yal s1,~rd
and I resided at _ However i have changed my domic,ile
(Street and Number)
to and am and have been a bona fide resider.t of the State of Florida since day of
Jn7-~ , 19. 65and I r~side at _~'6 G~p8Y`g'1]-s~ ~~^°_nnaj___PArt St,_ Luci~
{5treet and Number)
FOIt7 PiERCE, 5AINT LUGE COUNTY, ~LORIDA
and th~s statement is ta be taken as my declaration of citizenship, actual legal residence and domicile in the 5tate of Florida.
(Insert here any pertinent facts, sucli as sale of property or business, or relin~uishment of empioyment
at former domicile, remaval nf family to ~ew domicile, purcha~e of home, etcJ
F~~-~~ ANa RECORDED
, .
C~ ~£-!~d p 0 0 K ~
~ ,
65 D~C 9 AM I I: 2 7
Establisng residence 1 ~ ~ ~i
F;OG~i~; i; r';,~ CLF t^~K
ST. ~~Clt CnUNTY,
.
r LORIDA '
`
~
.
f':
-n -
, `
~
~ '•~.v~+'~,y ,~,~„s .
•'.n' '~'~f• .
! FURTHER CERTIFY that I will comply with al! ~ther requiremenfs of a tegal resident,of #hfs', fath:
I FURTHER CER7IFY that ! have ro intention to return to my former domi~ile, and I interid ta r~main in FOR7
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanentiy.
~ - - ~
~ • ~ . (Name)
.
. .
- . . • . -
- ,
_ , . .
. . : . M. J. Che~tr
. .
,
.
_ . , , - -
• - = (Address)
' . .
- ~1.
, .
~.~.~j~~+:~it ~ 5
Sworfrtt ta and subscribed befcre mE this _ day os ._.____~~~ber ~ W 19 b
ROGER POITRAS _
CLERK C CUIT CQURT Nosary Public
gY ~Z~~ _ - D.C. My Commission expires
(To be exesuted in duplicate and origina) file~d wi4h Clerk Circuit Court, and dupficate witlt Tax Assassor.)
aoo~1~2 5iu