HomeMy WebLinkAbout1393 Declaration ot Domicile and Citizenship ~
14sssi
TO THE STATE AND COUNTY TAX ASSESSOR,
51. IUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in aotordance and
~m m~fo~mity with Chapter 222. Section 222.17, Florida Statutes.
I was forme~ly a legal resident of Ailamuchv New JerseF -
(City) (State)
Box 17,
and I resided at However 1 have changed my domitile
(Street and Number)
4
to and am and ha~e been a bona fide ~esident of the State of flo~ida since day of
September 66 4307 /~enue 0
, 19_-, and I reside at
(Street and Number)
FORT 17:RCE, SAINT LUCIE COUNTY, FLORIOA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
(Insert here any pe~tinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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~ntering Bvan Gouger in 8th Grade
~ " James Conklin in 6th Grade T ~~r
" Keith Allea Conklin in lst Grade ~o ~~v
" Catherine Conklin in lst Grade ~m _ o~D
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A
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A
' O N~ N ~
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I FURTHER CERTIFY ihat I will comply with al) other requirementa of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT
PIERCE, SAl1~l~,lU~IE COUNTY, FLORIDA, permanently.
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.~t•~-
. , .
i :.1~a' ~,r 3 (Name)
7 . Mar Carter
.i- c ! ~ y
'
'~.~`'~~:'~v (Address)
~ ' •i:... . ~
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Sworn to and subscribed before me this 19 day of September ~ ~q 66 ,
ROGER POITRAS
LERK CIRC IT COURT Notary Public
gy D.C. My Commission expires
(To bs ~xecuted in duplicaM and originsl ~iled with Clerk Circuit Courf, and dupliute with Tsx As~ssor.)
eoo~ 155 ~91
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