HomeMy WebLinkAbout0353 DeClaration ot Domicile and Cittsenship ~
14'7954
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA:
This is my declarotion of Domicile and Citizenship in the State of Fiorida that I am filing this day in accordance and
;n conformiy with Chapter 222, Section 222.17, Florida Statutes. .
I was formerly a legal resident of ___Ctierel~! _ North Cgrp,ti~8
(City) (Stab)
and 1 ~esided at ----Rt - 1-- - - - . - - - However I have changed my domicale
(Street and Number)
to and am and have been a bona fide resident of the State of Fiorida since ________~~h__~_ day of
g t
~ll_USt_ 1966 , and I reside ~f"ven Del. U,$~ ~ at Indr~r~
(Street and Number)
FORT PIERCE, SAtNT LUCIE COUNTY, RORIDA
and this statement is to be taken as my dectaration of citizenship, actual legal residence and domicile in the State of Horida.
(Insert here any pertinent facts, such as sate of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
~ntering~ children in 3rd, Sth 6th grade
and in the 8th grade
FIL.ED AND RE
~Y
~ A-
ST. LUC~E COURIFIGD -
1~ E C ~ s'oK~
F~~ ~ ; 5 u
-66 1~6 2 5
14'7954,
~
' L C P,i
CLEfiY: CIRCUt ,
_ ~
}
!
4
; I FURTHER CERTIFY that I will oomply with all other requirements of a legal resident of this Sfafe. ~
~
' I FUR7HER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT ~
,
PIERCE, SAINT LUCiE COUNTY, FLORiDA, permanently_ ;
!
.~~stf:( -
E r: - ~
~ •~,n ~J•J ( iS,T n':/~~ i • ^ ~
; ;=G~: •f.==
; ~ (j~tame)
. : '
; ;t . ' ~ es ~tu Mesiemore
:n'l M •r"' c:v -
_1 . , f;; , '
~F
. " i ~ • ' ~T : ~ (Address) f
~ f•, ~V: i
~n~'• ~~•Z ;
: • i,e•~.,.:`` ;
Swbrn~to~'and subscribed before me this 2 Stb day of AvguSt ~~q 66,
ROGER POITRAS ~
CIRCUIT C~ RT Notary Public ~
' G`~ 'G~"
i By D.C. My Commission expires
' Ro be executed in dupliwts and original filed with Clerk Circuit Court, and duplicsM with Tax Ass~ssor.)
I
t
~ ~oo~ 153 - 35~
`s~*~"~ ~ A-~ ~ ~ - . . - -
.r ~