HomeMy WebLinkAbout0488 O~Cla~a#ion ot Dom~cile und Citizenship
14~8%~
TO THE STATE AND COUNTY TAX ASSESSOR, ?
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51. Li1C1E COUNTY. FLORI~A~ ~ :
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This is my declaration of Oomicile and Citizenship in the State o~ Flo~ida that 1 am fili~g this daj? in acco~daRCe a~d 1
~n confo~mity with Chapter 222, Section 222.17, Florida Statutes. ~
1 was formerly a legal residenr of ___p4rt ~and _ Tt?xas 1
(City) (Sfab)
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and 1 ~esided at _229_COtlgies~ StieCt However I have changed my domiG~e
(Street and N~rnber)
to and am and have been a bona fide resident of the State of Florida since b th day of
A November`, 19_66, a~ i,eside at ._221 Osceola Ave.
(Street and Number) i
FORT PIEltCE, SAINT LUCIE COUNTY, RORIDA ~
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and this statement is to be taken as my declaration of citizenship, adual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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Entering High School
~ 1°#tE0 AND RECORDE~ ~
ST. LUCIE COUNTY. FLA.'
RECORD V~RIFIED _ i
`-~,~~~~.~r i
~66 NOV e pM 3: I9
14~823 a
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ROGER FOITRAS
6lERK CIRCUIT COURT .
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I FURTHER CERTIFY that 1 will 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 ta my former domiqle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. #
i; ~•j r`~!~~``'!• ' ' ~ ' ~y (,[~_Q/~J~y ~
~ • ~i4~ ~ L'~~ ' . / ]/~N~/L~ f/ ~.C/ .~1~~~~%~l~ ;
; - - (Namej ~
~ ~ s~ . Linda Penland `
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' ~ ti (Address)
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~ Sworn to and subscribed before me This 8th day of November ~ ~~i6 i
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ROGEit POITRAS }
CIRGUIT CO T Notary Public ~
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~ (p 7~7'Ti~`~~Y e
~y O.C. My Commission expires ~
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~ (To bs ~xecuted io duplic~te and original filad with Ge~lc Grwit Cour~, and duplicats with Tax Ass~ssor.)
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~ 600K ~v0 PAGE 4~ ~
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