HomeMy WebLinkAbout2177 Oeclaration ot Domicile and Cittzenship ~
1490~2
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizensh~p in Ihe State of Florida that I am filing this day in accordance a~d
in conformity with Chapte~ 222, Section 222.17, flo~ida Statutes. '
I was formerly a legal ~esident of CQ1uIDi2WS.___ Oh10 _
(City) (State)
and 1 resided at ___Rt 4 Pataska
- - - - - _ . However 1 have changed my domitile
(Sireet and Number)
to and am and have been a bona fide resident of the State of Florida since Sth day of
October 66 3426 Carlisle
- - 19 and I ~eside at
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, adual legal residence and domicile ;n the State of Florida.
(Insert here any pertinent facts, such as sale of properry or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
~n~e~ine _Tames D in the Sth grade
" Gina M in ~ht 2nd grade ~
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~~~o ANO aff~pRo~o'
. ST. IUCIE COUNI`Y. I~LA.
RECORD VERIFIE~
..a~rJ~c'G.t.G~ `
'66 OCT 10 IW 10:0~ -
RO~ER o~
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CLERK CIRCUIT COUR7 '
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1 FURTHER CERTIFY that I wil! comply with all other requirements of a legal resident of this State. ~
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I FURTHER CERTIFY that I have no intention to return to my former domitile, and i intend to remain in FORT
PIERCf, SAINT IUCIE COUNTY, FLORIDA, permanently.
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Sworn to and subscribed before me this • lOth day of OCtObet ~9 66
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ROGER POITRAS
CIERK CIRCUIT COURT Notary Public
g ~'G Z~~~~'~'~ D.C. My Commission expires
(To be ~xecuted in duplicate and original filed witb Glerk Circuit Court, and duplicat~ with Tax Assessor,)
goox 156 e~cE 374
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