HomeMy WebLinkAbout1764 Deciatation ot Domicile and Citizenship J
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E ~OUNTY, FIORIDA:
This is my declaration of Oomicile a~d Citizenship in the State of Florida that 1 am filing tF~is dsy in aaordance and
in confo~mify with Chapter 222, $ectio~ 222.17, Florida Statutes.
I was formerly a legal resident of w1~StOQ- Salem _ _ N. C8tOlitli
(Ciy) (State) -
and I resided at Rt -2 However I have changed my domi~ile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since 27th day of
SektE'~E~__-__ t966 , and 1 reside at ?2a Sp llth _
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA ~
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 pertinent facts, such as sale of property or busiriess, or relinquishment of employment
at former domicile, removal of family to ~ew domicile, purchase of home, etc.)
fintering-
Rita and Shirley in Blementary grades
F~E4 AMO
8T. IUpE CQU .
' • - - RECO vERI~IC
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~ : 66 SEP Ye AM 9 . !s
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. ~ • . ~ CLERK R PO~TRAS
ciacu~r couRT
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1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
1 FURTHER CERTIFY that I have no intention to return to my former domic,ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently_
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(Name)
Dorothy Carpenter
(Address)
Sworn to and subscribed before me this 28t1i day of Se-ptember , 19 66 ,
ROCsER POITRAS -
LERK CIRCU T COURT Notary Public
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By D.C. My Commission expires
(To b~ ~x~cuted in dupliub snd oripinal ~il~d with Cltrk Grsuit Cour1, snd duplipt~ witl~ Tsx Ass~stor.)
ao~x 155 ~ 561
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