HomeMy WebLinkAbout1395 ~eclaratlon o! Domtcile and Citizenship 9
TO THE STATE AND COUNTY TAX ASSESSOR, 1485s3
Sl. WCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Gitizenship in the State of Ftorida that 1 am filing this day in a~ordance end
in conformity with Chapte~ 222, Section 222.17. Flo~ida Statutes.
1 was fo~merly a legal ~esident of Santa Rosi Califern;a _
(City) (State3
219 Ricardo e. ~ However 1 havechanged my domitile
and I resided at A]!
(Street and Numbe~)
to and am a~d have been a bona fide ~esident of the State of Florida since .____16th_ day of
September ~6 2712 So 17th St
19
66, and I reside at
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my decla~ation of citizenship, actual legal residence a~d domicile in the State of Horida.
(Inser~ he~e any pertinent 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.)
Bntering Alan Johnston in the 6th grade
Establishing residency
s~~° ~HO r~ ~
RECpR COo
VERIFI~ -
. SEP ~ 9 pM ~
14~3 s
~ R6GER i'OtTRqg
~ ~~K G1RCU1fi t30URT
I
I FURTHER CERTIFY that I will aomply with all other requirementa of a legal resident of this State.
'~~~~;.I~1~bTHE$ C.~RTIFY that I have no intention to return to my former domiSile, and 1 intend to remain in FORT
L~a •
, i.
P1ER~ iSAA~ljc~tlL1E LQIfNTY, FLORIDA, permanentty.
~
' ~ " ~a`'- = ~ ,
" . ~ . • ~y.~ ` - " . x' ~ 7 l.
:n;: ~L ^ . ~ _ William J ~ ton -
-
'~~~''•'~,U~ t E• .~'O'
~ (Address)
Sworn to and subscribed before me this 19th day of Se~~emhe1 , 19~bb_.
ROGER POITRAS
CIRCUI~,CO~ Notary Public
1~
By cz`-'~`'~ ~O D.C_ My Commission expires
(To b~ ~xecuhd in duplicaM snd original filed with qKk Grcuit Cour~, snd duplicat~ with Tsx Ass~ssor.)
BooK 155 ~93 -
€ x ~ ~
'
: