HomeMy WebLinkAbout0350 i
DeClaratlon ot DomiGile a~d Citize~ship ~4~5
I
TO TNE STATE AND COUNTY TAX ASSESSOR,
S7. LUCIE COUNTY, FlOR1~A:
This is my detlaration of Oomicile and Citizenship in the State ot Florida that 1 em filing this day in accordante and
in conformity with Chapter 222. Section 222.17, Florida Statutes.
Bssexville Michigan
I was formeriy a legat resident of . _ _ . _
(Ciy) (State)
1245 Scheurman kOad However I have changed my doMitile
a nd 1 resided at - - - - - - - - -
(Street and Numbe~)
to and am and have been a bona fide ~esident of the State of Florida since 232d___ day of
~~iguSx___ 19~_, and I reside at ~ 3235 SO. Federal Hi.ghwa~ .
(Street nnd Number)
PORT PIEACE, SAINT LUCIE COUNTY, RORIOA
and this statement is to b~ taken as my declaration of citizenship, actual legal residence and domicite in the State of Horida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to ~ew damicile, purchase of home, etc.)
fistablishin~ residence ST LEO AND RECDRDED
LUCIE COUNTY
+~~RIFtFFLA.
Entering Gary in the 4th ~rade D
~~S '~t~ zS a'~ : 1 I
14~~gi
~:~:,~.i? i~~j,; ~l.j
CLERK CIRCUrr GOURT
1 FlJRTHER CERTIFY that I wiil compty with all other requirements of a legal resident of this State.
; I FURTHER CERTIFY thai ! have no intention to return to my fo~mer domic.ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
;.:.:.,~1r~:
_tip . ;S ~
~ . .J _ - (Name) 4
" . c: ~f Charles Cook +
~
• • : .i •y. . r ~ ` ~
~jt (Address) ~
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Sworn to and subscribed before me this _ ~ 5t h day of ~tl~
ust , 19.6b__.
~
F ROGER POiTRAS
CIRCUIT OURT Notary Public
! Q ~
By ~ D.C. My Commission expires
~
! (To be executed in dupliute and originsl filed with COI R Grcuit Court, and duplicate with Tax Assessor.)
$Q~K153 35p
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