HomeMy WebLinkAbout1305 Declaration ot Domicile and Citizenship ~
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TO THE STATE AND COUNTY TAX ASSESSOR, ~ ~
Sl. LUCIE COUNTY, FIORiDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordante and
in tonformity with Chapter 222, Section 222.17, Florida Statutes.
1 was former~y a lega) resident of _ V81dOSta Georgia
_ . _ . - - - - -
~C;ty~ (State)
Route 3 Box 43
and 1 res~ded at _ . . _ _ _ ~ _ _ . However I have changed my domitile
(Street and Numbe~)
to and am and have been a bona fide resident of the State of Florida since 13 day of
~Y_ ~q___6~nd I reside at _____368 Johnson Street~ white Cit~_
~ (Street and Number)
FORT PIERCE, SAINT LUt1E COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(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.)
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Batablishing residence
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aooK
_ - _ . . ~ •AN ~j~~
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1 ~ 10
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; cf° ' '66 ~ ~ ~ `'~;5 c~-~~K ,
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I FURTHER CERTIFY that I will comply with al) other requirements of a legal resident of this State. '
1 FURTHER CERTIFY that I have no intention to retur~ to my former domicjle, and I intend to remain in FORT
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PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently. !
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~:~--t'°~, <-c~~~~- ~
~ . ~ (Name)
~ - • Isom Chauncey
n : : , (Address)
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'•.S~Npt~.lo arad•~u6sctibed before me this 21 day of _ ~rCh ,~q 66
• ~ .
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~ ROGER POITRAS
CLERK CUIT GOURT Notary Public
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gy - D.C. My Commission expires ~
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~ (To bs ~x~cuted in dupliuts snd orig+nsl fil h C Grcuit Court, and dupliut~ with Tax Ass~ssor.)
1 ~.02
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