HomeMy WebLinkAbout0606 ~ ~eCla~ation ot ~orr~iCile and Citisenship ~
1~33`~5
TO THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FLORIDA:
This is my declaration of Uomicile and Citizenship in the State of Florida that I am filing this day i~ accordanoe and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a ie9ai ~es~denr of Muskegon Michigan
(City) (State)
3213 Gaendale
and I resided at -_T_____ _ However 1 have cha~ged my domiCile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since 1 day of
March 66 2825 S 4th atreet
, 19 and I reside at
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORiDA
and this statement is to be taken as my declaration of citizenship, actual legal reside~ce 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.)
~~~~~~RDED K
,F~~tG1
Rs
Bntering Lorie Joe Clark in 3rd Grade ~
" Jerry Lee Clark in Sth "rade ~ 9~22
'66 N'~R 1~3~%~~~
! RO~E~ c';;: ~ :::~5. C~ERK
! ST, LiJC1E COUy7Y•
~ FLORtDA
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I FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident-o~'#~iti,~.t~Mj;'~a.'`','..~,.+`~~
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I FURTHER CERTIFY that I have no intention to return to my forrr~er domicjle, and I'iri~'__, ,~Fk+f FORT '
; ~t~ -ri.`;'. ' • '
_ ,,r . :
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ' ,
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- . . • ~dne Smith
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Y ~ "::~.s ~ ` = -T (Address)
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w~, t:'~,,,~ ~ _ March 66
'Si~VoMtr~tO~and subscribed before me this 7 day of , 19 .
ROGER POITRAS
UERK CUIT COURT Notary Public
gy ~1~ _ D.C. My Commission expires
(To bo ~xeevt+d in duplicat~ snd ori~insl Rlsd whh G~rlc Circuit Court, and duplicat~ witb Tax AsMSSOr.)
$o~ 140 3 ~
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