HomeMy WebLinkAbout2550 Decla~atio~ ot Domicile and Citizenship ?
149~28'~
TO THE STATE ANO COUNTY TAX ASSESSOR,
Si. lUC1E COUNTY, FLORIDA:
This is my declarotion of Oomicile and Citizensh;p in the State of Florida that 1 am filing this day in acoordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was forme~ly a legal resident of _ BY00$~D New York
(Ciy) (State) -
and 1 resided at _________915_ 84th Street , However I have changed my domitite
, (Street and Number)
to and am and have been a bona fide resident of the State of Florida since 14 day of
May 66 ~ 114 Lucero Drive Port St.Lucie
_ _ _ , 19 and I reside at _ ~
(Street and Number)
FORT PIERCE, SAIN? LUCIE COUNTY, RORIDA
and this statement is to be taken -as my declaration of citizenship, actual iegal residence and domicile in the State of Horida.
(lnsert here any pertinent fads, such as sale of properry or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Establishing residence ~ ~ OUNTy~~ .
RECORD V qfF1ED~'
'66 OCT 18 p~ [2 : I 4
14928'7
CLERK eR ~~YRAS
~~RCUfT COURT
~
~
1 FURTHER ~ERTiFY that 1 will oomply w+th all other requiremer~ts of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former_domiCile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently:
~r G.
,.,i.~~~~,,;,,~, Philip J. Clark ~ ~z
, .
. . . ~ a~~
_ _ . . : Yiola C~ Clark ~ r
~ . • - (/i~ii~)
.,,J • u ` q,+~
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~ ••SvYorrS ta and subxribed before me this 18 day of OGtObCr , ~q 66
' . ~'t~-~ . -
_ ROGER POITRAS
CLERK IRCUIT COURT Notary P~blic
.
BY D.C. My Commission expires
(To b~ ~xecut~d in dupllcats s~d original filed whh Cl~rlc Circuif Cou~f, and duplica» with Tax Ass~ssor.)
ao~ 157' P~~ 149
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