HomeMy WebLinkAbout2757 Decia~ation of Don~icile and Citizenship ~
TO TNE STATE AND COUNTY TAX ASSESSOR, ~ ~
51. LUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in acto~dante and
in conformity with Chapte~ 222. Section 2~2.17, Florida Statutes.
I was formerly a legal resident of _TOledO Ohio
t~;ty~ (State)
and I resided at _ 1302 Wave r ley Howeve~ I have changed my domitile
(Street and Numbe~)
to and am and have been a bona fide resident of the State of Florida since 17th day of
Oct~g=____ _ ,~91t.~, and I ~eside ar 2505 Tarpen Court
(Street and Number) , .
FORT PfERCE, SAINT LUCIE COUNTY, RORIDA ~
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and this statement is to be taken as my declaration of citize~ship, actual legal residence and domicile in the State of Horida. •
' (Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
, . .
Establishing residence . ~
~E ~ ~r~~i ~
RECORD VER~Ep~
~ ~ '66 OCt 2 q AM 9: 51
, ~ .149414
ROGER AOtTRAB
CLERK CIRCUIT COURT
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1 FURTHER CERTiFY that 1 will comply with all other requirements of a lega) resident of this State.
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1 FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain i~ FORT
PIERCE, .S~AlN;~Lt~CIE COUNTY, FLORIDA, permanently.
• ~ ~i ! . i
.i` ~
. ' ~ ;
~ I
~ . + ~G~~G't~ ' r (Name) i
~ z~'`; ~y ~ Dewey O. Shaver
. - :J;
~ _ . _
~ ' • .~.j,, . (Address)
IJ`~~ ~
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Sworn to and subscribed before me this 24th day of October ~ 19 66
ROGER POITRAS
K tIRCUR COURT Notary Public
gy ~~''G~~' D.C. My Commission expires
(To bs ~xecut~d in duplicsts and ori~inal ~iisd with Cl~rk Grcuit Court, and dupliab with Tax Ass~ssor.)
aooK 15 ! PACE 356
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