HomeMy WebLinkAbout0143 ~
Oecla~ation ot Don~icile and Citize~ship -
TO THE STATE AND COUNTY TAX ASSESSOR, _ 147826
Si. WCIE COUNTY, fLORIDA: ~
This is my declarotion of Domicile and Citixenship in the State of Fiorida that 1 am filing this day in acoordante and
in ca.formity with Chapter 222, Section 222.17, Flo~ida Statutes.
1 was formerly a legal resident of - parma~ - ~hi=--
(Ciy) (StaM)
and I resided at _ 3318 WC l lin~tOn However I have changed my domic~le
(Street and Numbe~)
to and am and have been a bona fide resident of the State of Florida since _ 1?t h day of.
.
August ~ 19 66~ a~ ~ reside at 504 Bmil Av . -
(Street and Number)
FORT MERCE, SAINT LUCIE COUNT1f, RORIDA '
and thi~ statement is to be take~ 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 ~
I
st former domicile, removal of family to new domicile, purchase of home, etc.)
Bntering children in school
Bstablishing residence
FtLE~ ANp RE~ORf~
aT. I.UCIE CAUNTY. l~A. ~
RECOR VERIFtEO
GK.~
'6~ AUG t 9 PM 3: y 0
14'7826
~ ROGER 'r01TRAS
; tLERK CIItCUtT ~OURT
~
~
I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that 1 have no intention to return to my former domicjle, and I intend to remain in FORT
PIERCE, SAIN~ ~yCJ~ C~~,Ol1NTY, FLORIDA, permanently.
f.lJ~j .':a
` U i;.~C . _ .
G~I ' e
' ,1 V• .i....~~~0 : ~
~s~v~~,rt'•s ~ ~~~~i~;t
_ ' ~j ' ' , L~.~. .
: ' , ,T (Name)
~ ,~i,~ ' ; s ~ Herbert C. Brooks
. ~V• Y • -
^ ~l . i.1~ Q
=i , i • . . . ~,J ~
~ ~ ~ ~C = (Address)
_ .
~ ~.,~~`~e;~..vO`,,,,
~i~r.~~~~ii~~~`'
Sworn to end subscribed before me this 19th day of 191~b.._.
ROGER POITRAS
CIRCUIT C RT Notary P~~blic
~.c.G C~~ ~
g D._. My Commiuion expires
(To bs ~x~cut~d in duplicsh snd orisinsl filed wi11~ G~rlc G~cuit Court, and duplicat~ with T~uc Ass~ssor.)
. ~ooK 153 143
- ~ ~ ,~-R. -
- o~ .
~