HomeMy WebLinkAbout0045 ~ - ~
.L43t1(~~3 ~
Declaration of Domicile and Citise~ship '
-
TO THE STATE AND COUNTY TAX ASSESSOR, ,
Sl. IUCIE COUNTY, FLORIDA:
This is my declaration of Oomicile and Citizenship in the State of Florida that 1 am filing this day in actordanoe and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
~
1 was formerly a legal resider~t of ___pOCBSSCtt ~tSS• _ ~
(Ciry) (Stab)
P.O.BOx 148 . Howeve~ I have chan m domiule
and 1 resided at - - - - ~ y
. (Street and Number) ;
to and am and have been a bona fide resident of the State of Florida since _-_1~2lh,- day of
~ ___Februar ~ ~q _ 66and 1 reside at 313 Notth 20th street
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
a~d this statement is to be taken as my declaration of citizenship, actual legal resid~nce and domicile in the State of Horida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
i
i
bntering child in school
~
RE RD '
~rF~~ BEDK 5
'66 FEB 22 QM • ~~``~l~ _
143t? 1~ OS
ROGER P~t;-r;,;~, CLERK ~
ST. LUCIE COUNTY. ~
FLORIDA .,.t.,..~::?r;,:~ .
_ ~ ~ Q
~~4~s:
~t .~"~ii.
~~~A'~'J ~~~~~~4~~~; ~~Ll~~ ~
v ~ ~ ;
- Y,. '~i~`~^~'. • . ~
• . y
: O'= ~...tf. ~ i
~ ~•~~?~~'.;P~~'r.~:-~•~•~ -
I FURTHER CERTIFY that I will comply with all other requirements of a(egal resident of~~i~ ~~'~'y =
1 •
-.•'•`4 ~~(~(f~ ~
-I~~V`l•~ iru f~~~~~T
' t.~ ~~~i!!~• n : ~ -
:`~!1•
1 FURTHER CERTIFY that I have no intention to return to my former domicjle, and 1 inten~%!q y~rfi~iritiA•~PORT
PIERCE, SAINT LUCIE COUNTY, FLORlDA, permanently.
s
_ ~ ~ ~ -~lto .l~i ~.v~ ~CS'.ca o1,1'~
' , . ~ (Name
, ~ -~~'~'E~ Mrs. Richard ~issell ~
. •
; :~~s ~ ~ c:•
L ~ Z . ' ~ ~ , • ~ , .
. . ~ i - ( 4 I, I~~ • .
. ~i ;`.~'.`~.':j, ~'~-.'c : - (Address)
.sr~ 1: . •
_ • ~-j•:~~;-`~ 4 ~
' =~f , ~,r. ' ~ = 66
~''r~ ' - 22nd Feb
..~rq~t~,tip.:ati~I~~ik~eil' before me this day of 9 •
~ ,
'~i~
J ~ t
; C: ;ti~` . ~
Rooi~t.,poi~?'s
CIRCUI COURT . Notary Public
gy '~'L D.C. My ~ommission expires
(To b~ ~x~cuhd in dupliut~ aed ori~ina! filed with B~ Grwit Cou~f, and duplicat~ with Tax At~or.)
~139
~2 .
.
~ . ~ ~ . ~ _ . . :
. - _ _ ~~~:~j- ~