HomeMy WebLinkAbout2937 Oecla~ation ot Domicile and Citisenship . ~
TO THE STATE AND COUNTY TAX ASSESSOR, l4 `VC7I
Si, IUCIE COUiVTY, FtORtDA:
This is my detlaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in acoordance and
in co~formity with Chapte~ 222. Section 222.17, Florida Statutes.
1 was fo~merly a legal resident of F~lls Church~ Fairfax CouDty Virgiqia
~ (C~ty) (State) •
and I resided at PS11S ChurCh ~M,ever 1 have changed my domic3le
(Street and Number) ~
to and am and have been a bo~a fide resident of the State of Florida since 14th day of
_ August ~ 19 66 ~ and I reside at 8305 So Ind.River Dr~~e_
(Street and Number)
FORT MERCE. SAINT LUCIE COUNTY, FLORI~A _
and this statement is to be taken as my declaration of citize~ship, actual legal ~esidence and domicile in the State of Horida.
(Insert here any pertineni fads, such as sale of property or business, or relinquishme~t of employme~t
at former domicile, removal of family to new domicile, purchase of home, etc.)
Bntering children in school~
Slementary and Jr. High scbooi
,
11.E0 AN~ 0
1!1'~YS~?
REC~
~ VE~I~~~~
~"~`,c~' ~2 : 3~
,66 p~G ~5
PM '7
14
Ro~~
R~~
~
68uRT .
s~RK
1 RIRTHER CERTIFY that 1 will comply witfi all other requirements of a legal resident of this State.
~ I' FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT IUCIE COUNTY, FLORIDA, permanently.
F • ~ ~
} ~
.:,y-,l~-''.• r?'.~.~vY -
` ~ ~
~ ,v 1~r~
Cp! ' eme)
r - Ma.ry E.
~ ti_ ~ , - Greene
~ •JO~ti!'~~rc• •,ti":.
; c, :
y . ~ :
,~:~~"`=.-,~Gw;~. ~
~t" t% G L'?
= - ~:..:-~t , _ (Address)
r . -.x.=~• ~ .
, i.t3~'~f ~ ~ Q ~
. - ~ :~v ;
~ . ~ :
~~orn~tp?bnd,~vbscribed before me this 15th day of _ Augu5t , ~q_~.
, 1!~?~~ ~4•;:
~ ~ ~ : i+'•~''~~
ROGER POITRAS
CtRCU1T C RT Notary Public
~.,e- ~c~~.~l.~.~l~~~ .
By D.C. My Commission expires
~ . .
(To b~ ~x~cuted in duplicat~ and oripinal ~ile~d with Cleelc Cirtuit Co~rf, and duplia» wifh Tax Ass~ssor.)
BQOx 152 5~36
'=v-R -...i_ iw~/,ca .Y.r . _ . . . • . ~ . _
-l~ „L v .v'" ~ ~-Y.$'• F"r~~ ~ r ~ . . _ . . _ - . ~a _
f~ . ,
~ ~ '
~ ~
°