HomeMy WebLinkAbout2986 ~
Decla~ation ot IDomicile a~d Citisenship 149546
TO THE STATE AND COUNTY TAX ASSESSOR, _
Sl. LUCIE COUNTY, FLORIUA:
This is my declaration of Domicile and Citizenship in the State of Ftorida that 1 am filing this day in accordance and
in conformiry with Chapter 2~2, Section 222.17, Florida Statutes.
I was formerly a legal resident of ~~~U~_---~ N T _
~C~ty~ (State)
1304 N. Y. Ave.
and 1 resided at - . However 1 have changed my domiti~e
(Street and Numbe~)
to a~d am and have been a bona fide resident of the State of Florida since 6th day of
October 65 R. R. 2 Box 3045-Salerno Rd.-Lakewood
. 19----, and I reside at S~-
- (Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FIORIDA
I
and this statement is to be taken as my decla~ation of citizenship, actuat legal residence and domicile in the State of Florida.
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of empJoyme~t
at former domicile, removal of family to new domicile, purchase of home, etc.)
~
~
Fi~o ~o REC~o '
F ILING FOR HOMESTEAD PURPOSES ST. LUCIE COUNTY. FIA.
RECORD VERIFIEO
G~,%E~~.~=
'66 OCT 28 PM ~ : 22
149546
:,o~c~ ~•ot7~as
CLERK CIRCUIT COURT
~
I RJRTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domiGle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
l/ V
(Name)
~,,iitst~trrr:::r~.. EDWARD L. WURTH ,
, ~~T c ~ - ~ " '
• G ~ ; ; ;
.
~ ;
'~4 . •ut•.,j . ~
~ ~ ~'J ~ j (Address)
J ~v, "p • Yf ,
- ~ ~.~e Y ~ ~ 1 ~ ' ~ -
• • . '
~ : 28th October , 19 66
Swo~e~~Q;~nd subscribed before me this day of •
.
. : . ~
. ~~~ER RAS
CLER C T COURT Notary Public
C
gy D.C. My Commission expires
(To be ex~cu in duplicate and original filed with Clerk Grcuit Court, and duplicat~ with Tax Ass~s~or.)
~~.57 ~ 585
_ _ { ~~~w
~
_ ~ ~ . ~ .;u:~::;.~,y,.r
~ ~ ~ ~
-