HomeMy WebLinkAbout1781 Declaration ot Domicile and Citizensh~p
TO THE STATE AND COUNTY TAX ASSESSOR, /s~p0 ~
Sl. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Ftorida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
Halifax Vir inia
1 was formerly a legal resident of ~ _ _ _ _ _ . _ _ _ _
(Gty) (State)
2509 Halifax Road
and 1 resided at _ _ However 1 have changed my domicjle
(Street and Number)
14
to and am and have been a bona fide resident of the State of Florida since day of
SQptember 64 359 Barraclou~h Street
- - 19- and I reside at - - - - - - -
(Street and Number)
FORT PIERCE, SAIN? LUCIE COUNTY, ~LORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert h^re 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.)
~FILED AND RECOR~OOK
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_
Establishing resiaence ~ss ~ 3 ~
_1 ~ 1':
ROGcF 's'~+ ~ i::.~. CLERK ~
ST. LUCIt COUNTY.
FL~RtDA
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I FURTHER CERTIFY that I will comply with alt other requirements of a legal ~esident of this State: ~
I FURTHER CERTIFY that I have no intentia,i to return to my former domiCile, and 1 intend to ~emain in FORT
PIERCE, SAINT lUC1E COUNTY, FLORIDA, permanently.
;fiic , ; - , _(f n
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: - ~ ' (Name) \
~ '4' - ~a. _
~ , ~ ~ ~f~` ~ f,•'~~.:I~ - ~ lQJC Breinard ene Palmer
+;r ' . . t J
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~ 7 ` (Address)
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~ ' • ..t~C~~ , 30 March 6b
~ Sworn to and subscribed before me this - day of _ . ~9 -
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~ ROGER POITRAS -
~ LERK CIR IT COURT Notary Public
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~ gy D.C. My Commission expires
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~ (To bs sxecuted in duplicate snd original filed with Clerk Grcuit Court, and dupliwte with Tsx Ass~stor.)
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~ BOOK14~ 577
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