HomeMy WebLinkAbout0610 DeCiaration ot DomiCile and Citizenship ~ ~
. 14332~
TO THE STATE AND COUNTY TAX ASSESSOR,
51. IUCIE COUNTY, FIORIDA:
This is my decla~ation of Domicile and Citize~ship in the State of Florida that I am filing this day in acrordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was fo~merly a legal resident of NOrwiCh _ _ Conn _t; ~»t _
~~;ty~ (State)
135 Broadway
and 1 resided at However 1 have changed my domitile
(Sireet and Number) ~
4 ~
to and am a~d have been a bona fide resident of the State of Florida since day of ~
1
' 1
_ March _ , 19_66 and 1 reside ar 109 Roselyn ~lveaue
(Street and Number)
FORT PIERCE, SAINT WCIE COUNTY, RORIDA ;;jY~~rf
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and this statement is to be taken as my declaration of citizenship, actual legal residerxe and domiaile.~n tF?et$~q~e,qf:~d!•
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(Insert here any pertinent facts, such as sale of property or business, or relinquishment of;~r~lPlo~ihen*
:i~y =7 '.'~q;'{ S. , .
at former domicile, removal of famil to ~ew domicile, urchase of home, etc.) r•~_:: ,~~~t;~
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~~F~~Q AND RECORpEp
~ V~~y~-~ 800K
~ntering Cheryl Hart in Sth Grade
Neil Hart in 2nd Grade 'ps 1 1
.
1433~
ROGch ~iilrF;,:;, CLERK
_ ST. LUCIE COUNTY.
FLORIOA
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1 RIRTHER CERTIFY that I will comply with all other requirementa of a lega) resident of this State. '
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I FURTHER CERTIFY that I have no intention to return to my former domicjle, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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: r { - .~~~:;i>,,:E.~:;~ - ~4:, ~ ~ (Name)
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(Address)
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••.SWpr~ to.~~iq?~cribed before me this ? day of , 19~6
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ROGER POITRAS
CI UtT COURT Notary Public
gy . _ D.C. My Commission expires ~
(To b~ ~x~cut~d in duplicah and oripinai ~ilsd with Cl~rlc Grcuit Court, and duplicab wit~Tax A~ssor.)
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