HomeMy WebLinkAbout0352 Deciaration ot Domicile and Cltizenship ~
14~~53 ~
TO THE STATE AN~ COUNTY TAX ASSESSOR, '
Sl. LUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in sccordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
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1 was forme~ly a legal resident of ~.~~~.int ~hiII _ !
Kity) (51ate) ~
and I resided at __Rt _ 3_ BOX 62? Howeve~ 1 have changed my domicile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since ____1St day of
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~ -_.J.llly-___~__ , t9
66 , and 1 reside at ~
(Street an Number j f
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FORT PIERCE, SAtNT LUCIE C~UNTIf, FlORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Flo~ida.
(Insert here any inent facts, such as sale of property or business, or relinquishment of employment
af former domicile, removal of family to new domicite, purchase of home, etc.)
Entering ~obbin Lynn in the lst grade
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FILEO AND RECOAP~O
ST. LUCIE COUNYY. F~.A.
RECORD VE~IFIED
_.~Oati~`
'66 ~JG 2~~~9533 9 '
re;:~~ ro~7Rc,s '
5
CLERK CIRCUIT COURT ~
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1 FURTHER CERTIFY that 1 wil) comply with al) other requirements of a(egal resident of this State.
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I FURTHER CERTIFY that 1 have no intention to ~eturn to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, fLORfUA, permanently.
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~ ' { ; ~ (Name) 's
~ sj?-~ ' ~ Dana Blan ton ~
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Swor.n to and subscribed before me this - 25th day of - ~uguSt ~q~{~ F
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ROGER PORRAS i
K CIRCUIT C URT Notary Public ~
~~x <~c`~-l-e~~
a D.C. My Commission expires ~
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(To bs ~xscvted in duplicaM snd original ~iled witii Gark Grsuit Cour~, and dupliute with Tax Ass~ssor.) ~
gooK 153 35~ ;
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