HomeMy WebLinkAbout1034 Declaration ot Domicile and Citizenship D
1435~4
TO THE STATE AND COUNTY TAX ASSESSOR,
51. IUCIE COUNTY, FLORIDA:
This is my declarotio~ of Domicile and Citizenship i~ the State of Florida that I am filing this dsy in atoordante a~d
in conformity with Chapter 222, Section 222.17, Florida Statutes.
Bristol Tenaessee
I was formerly a legal ~esident of -
(Ciry) (State) ~
F
~
1
203 Tanglewood Drive
and 1 resided at However I have changed my domitile
(Street and Number)
to and am and have been a bona fide reside~t of the State of Florida since 19 day of
February 66 3211 Sunrise Blvd
_ 19--, and 1 ~eside at
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence 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.)
Bstablishi8g residence
fintering David James Bverett in lst Grade
.<f _ R~ ~ RE~oEo
° _ IN BOOK
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~ _ '66 MpR I p~ I : 09
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-v- 7 i~,. ~ ROGER Poi rRaS. CLERK -
~f;• : . ST. LUCIE COUNTY.
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; ~•:....•C,O FLORIDA
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I FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of thia State.
1 FURTHER CERTIFY that 1 have no intention to return to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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;l.:,,.,.t.
z ~t , (Name)
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~ . ~f ` = David R. Bverett
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~ ~ - .j•-_w r: ~ ~j (Address)
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~;~-,-.~:S~~n.t0 ~,Yubxribed before me this 16 day of ~rcb ~ 19 66.
~ 4. ~ 7 •
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~ CLERK CI UIT COURT Notary Public
~ 8y D.C. My Commission expires
~
Ro b~ ~x~cvhd in du icah and o~i~inal Rled with CIKIc Circuit Cour~, snd duplicata wi~h Tax Ass~stor.)
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~ ooK140 431
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