HomeMy WebLinkAbout0139 .
1 n ot Dornicile and Citizenshi
Declarat o p
- 1515`7'7
TO THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE ~OUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filin~ this dsy in scoordance a~d
in confcumity with Chapte~ 222, Section 222.17, Florida Statutes.
I was for~nerly a 149a1 ~esident of ChiCagO Illinois
(City) (State) .
and 1 resided at _ 6839 Chappe 1 _ , Horvever 1 have chanqad my domicjie
(Straet and Numbe~)
to and am and have been a bona fide resident of the State of Florida since 18 day of ~
July _ ~q 66 845 Airoso Blvd~ Port St. Lucie
, , and I reside ai
(Street and Number)
FORT ~I~CE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declarotion of citizenship, actual legal residence and domicile in the State of Horids.
pnsert here any pe~tinent facts, such as sale of property or business, or relinquishment of employme~t
at fwmer domic~le, removal of family to new domicile, purchase of home, eft.)
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RE~~RD
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Bstablishing residence . ~j JAN _
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C~ERK
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1 FURTHER CERTIFY that I wlll comply with all other requireme~ta of a(eyal ~esident of this State.
I FURTHER CERTIFY that 1 have no intention to retum to my former domicjle, and I intend to remain_ in FORT
PIERCE, SAINT_ LUCIE COUNTY, FLORlOA, permanently.
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~,.•``-::;L{3~*r~rC~~ff` _
, v~ ; (Name)
:
iC~' '~;y ='.Y,'~~
= ~~~•~,.~~i 4~~~~tl/ ~ ' .
-_~`1.rx,
wY~~~=.t~:;; • Charles H.- McCampbell
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i.7. t~'~r,~i,:~ri ' Ti . . _ ~/Wdf@SS~
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5 January 1967
~~/;~tior~d~~ribed before me this day of , •
1 . J.> _ . . '
C CU{T COURT Notary Public
gy ' D.C. My Commission expires
(To b~ ~oc~eeNd in e~pfieab aed ori~Mal filed wiN~ Cl~elc Grwit Courf, aed dupliuN wi~h Tax As~ora
QOOKlV~ ~ACE ~t~(7
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