HomeMy WebLinkAbout1665 Declaration ot Domicile a~d Citizenship ~
TO THE STATE AND COUNTY TAX ASSESSOR, _1 ~~~j~~•~(! !
Sl. !l1CIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formeriy a legat res~denr of F a i r f ax _ ~m r g i n i a
(City) (State)
~
and I resided at _ _ _ O~t 447 _ _ _ _ . However 1 have changed my d~mi~ile ?
(Street and Numbe~) '
i
~
to and am and have been a bona fide resident of the State of Florida since 14th day of j
_ June , 19_ 65and 1 reside at _ 18Q? SQ_~nd_xiver Drive
(Street and Number)
PORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
a~d 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 domiciie, removal of fami~y to new domicile, purchase of home, etc.)
Establishing residence
. . FIIED AND '~~R ~ OOK :
_ . ;
. - - _ .
_ : , _ ~ . . . ,ss r~'1~R 28 PM ~ : i s
~ ~ - i43`.)`~-« ~
. • . . . . ROGi~~' ~ , ~~c~U~vTYPK ~
~ : - . . , ST. LUCtc
- - FLORIDA
_
• .
I FURTHER CERTiFY that I will comply wifh all other requiremenis of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in FORT
PIERCE, SAINT LUCIE, COUNTY, FLORIDA, permanently.
, .
' - - ~ ' ' .
~ . . " ~y~ , _i _ -
~4 I Elmar ~ t~ebbins Warin '
- -
, r : ` . ;
' - .
. . ~ . ^ rl
' (Address) fi
` ' ;
:,;.;r~:.,~~~ ;
28th Marc~ 66 ~
Sworn to and subscribed before me lhis day of , ~q _
R ER POITRAS
K CIRCUIT C T Notary Public
~ .
aY D.C. My Commission expires ~
~
~
(To be executed in duplicate and originsl fil ith Clerk Circuit Courf, snd duplicate with Tsx Assessor,)
~ o i41 46
2
C
,.r• z: u ~
~ "~~sak., ..`~a. -s _ A ~ ~ _ _ _ ~ ~