HomeMy WebLinkAbout0471 Oeciaration ot Domicile and Citize~ship 14g~4~ ~
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citize~ship in the State of Flo~ida that I am filing this day in sooordanas and
in conformity with Chapter 222, Sectio~ 222.17, Florida Statutes.
I was formerly a legal rasident of LOS V 8S Nevada _
(City) (State)
and I resided at 712_ Lo~ Vegas Bivd, l~lcvvever I have changed my domicile
(Stre~t and Number)
to and am and have been a bona fide resident of the Stste of Flwida since 27th _ dsy of
~lugust 66 Sailfish Bst. So 25th Street _
_ , 19 and I ~eside at ,
(Street and Number)
FORT ~I~CE, SAINT LUCIE COUNTY, RORIDA
end this statement is to be taken as my declaration of citizenship, actual legal ~esidence and domicile in the State of Horida.
(Insert here any pertine~t fatis, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Bntering Kelly in the lst grade
- FILEO AND R~C~O
~1
ST. I.UCIE COUNTT: F~:1?•
REC~RO V~RIFIEO
'66 AUG 29 AM 9:22
' i48~0 _
~
~ ~o~~.a ro~zR~s
t CLERK CIRCUIT COURT
I RJRTHER CERTIFY that 1 will comply with all other requiremenri of a legal resident of this State.
1 FURTH~R CERTIFY that I have no intention to retum to my former domicjle, and I intend to remain in FORT
. .::ry,'.:
PIERCE, ~~=l~~~OUNTY, FLORIDA, permanently.
: ~ ~ •~~fJ
-t-j :j1 Cf StI;S~~ . .
- L~. . /,i., l~
• . i~ _
~ • . ` - (Nam
' . ~ i . . Jane Napier
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~ _ : .
~~t r,: ~ (Address)
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Sworn to and suburibed before me this 29th day of Au~uSt ,~q~_.
ROGER POITRAS
CLERK CIRCUIT COURT Notary Public
~
By D.C. My Commission expires
(To b~ ~x~aM~d in dupliuh snd ori~inal fil~d with Cl~rlc Grcuit Coue~, and duplfeat~ with Tu Ass~ssor.)
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