HomeMy WebLinkAbout2115 ~
Decraration ot Domicile and CitiYenship ~ ,~g ~ ,t ; ; ~ ~
TO TWE 5TATE AND COUNTY YAX ASSESSCR,
S~ . LUCIE COUNTY, FLORIDA
This is my declaration of f~omirile and Citizenship in the State of rlorida that I ani filing this day in accordan[e a~d
in cnnfc~rmity with Chapter 222, Section 222.17, Floric~a 5tatutes
I was formerly a legal resident of Ea.at Greenxich _Rhode Island
(City) (State)
and I resided at 90 May~lo~er D1`1ve However I have cnanged my domi~ile
{Street and Numbe~i
to and am and have been a bona fide resident of the State of Florida since 15t~ day of
- _ LG'Ce!'0.'~e7~' , l~s , and I reside at 160~} 59a~i8~T_ Ih'ive----- ~
(Street and Number)
FORT PIEitCE, SAIOdT LUCIE COUNTY, FLORIDA
and this staternent is to be taken as my declaration or citizenship, actuai legal residenca ard domicile in the State o# Florida.
(insert here any pertinent facts, sucti as sale of property or bus+ness, or relinquishment of empioyment
at former domicile, removal of farnily to naw domicile, purchase of home, etc.)
;
~
Ft~C~~~~ ~K .
F ~~ED ~ . . ~ : . - ,
Establishing reside~cy ~ i~~ y' _
~ 2 • 23 ~s~ ~ ~
j• „s.~
Q~ • ,z~ ~t
C 2~ ~ ~ . r: ~ ;
J~~~ ~ _ ;
~65 r~ X ~K ' ~ x ~
~
1~' L'J~'~~ ~ •
P`l- ? ` v Gr~~r•1 '~i, t.), . ~
~ t; f
~C . . . _
I FURTHER CERTIFY that i will comp!y with al! other requirements of a legal resident of this State.
i FURTHEh CERTIFY that ( have no intention to return to my former domi~ile, and I inte!-nd to remain in FURT
PIERCE, SAIN? LUCIE COUNTY, FLORIDA, permanently.
~
~ ~ ~ ~~Ir~ /'_L . ) y-s'Yii _J---
. . . ~ -
: ~ ' Raytnond ~e me~ Taylorsor~
~ ~ ' = 4'K_~~? ~ . i~~ -<-u-,-t.~
. . ir - - - ---tAddress) - -
~ i
, ~ . .
; . - Gertrude C. Ta~lorson
; j•; w....•ry ~ ~5
''Sv~blr~to~T~,#.~`ul~scfiE~ed befnre me tnis 2fith _ day of _ _ DeCel~tb6Y'- - 19-_.
ROGER POITRAS _
C~K CIRCUIT f,OURT Notary Public; ~
~ : ~ -t'. Cr'!a ~ E~ c~
gY~~. , D.C. My Commission expires
(To be executad in duplicate and original filed with Clerk Circuit Court, and duplicate with Tax Assessor.)
~ooK 1~4 30~?