HomeMy WebLinkAbout0171 ~
~eclaration of Dosnl~Lle and ~iti:enship
TO THE STATE PND COUNTY TAX ASSESSOR, 151. ~O1
51. IUCIE COUNTY, FLORI~A: .
This is my declaration of Oomicile and ~itizenship in the State of Florida that 1 am filing this day in atoo~danoe and
in conformity with Chapte~ 222, Section 222.17, Florida Statutes.
I was forme~ly a legal resident of Keningston ConneCticut
(Ciy) • (State)
1225 Hi gh Rpad .~~,,,sver 1 have changed my domitile
a~d 1 tesidad at -
(St~eet and Number)
ro and am a~d hsve been a bona fide resident of the State of Flarida si~ce 13 ~ day of
February 19 6Q ?53 CyQress Street
, , and 1 reside at
(Sheet and Number)
~ORT MERCE, SAINT LUCIE COUNTY, ROWDA
and this statement is to be taken as my decla~ation of citizenship, actual legal residenoe snd domicile in fhe State of Horida.
(Inse~t here any pertinent facts, sud? as sale of property or business, or rellnquishment of employment
at forme~ domicile, removal of family to new domicile, purchase of home, etc.) ~
FILEp qND RECORD~O
' ST. ECO~RD V~RjFj~~~' -
~stablishing residence '~T JAN 5 pN 2~ 3y
" j5~'~'Q1
fiOGER ~~p~TRAg
~L~RK CIRCUfT COURT
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~ I Fl1RTHER CERTIFY that I will oomply with all other requirements of a lega) resident of this State.
1 FURTHER CER?IFY that I have no intention to retum to my former domicjle, and 1 intend to remain in FORT
Pl~RC'E, SAINT LUCIE COUNTIf, FLORIDA, permanently.
, , ~ - ~ .
..•••''~'s-~': - F
• , (Name)
' +i~;3 ~ i,= ; " : . -
~ ,
4.:-`:~
~ ' = Mrs. Flarence -H. -A-lling
~ ~,e
: ; : ~ : (Address)
~~.t-
, ~ rir :
~ 't
,F .
'`'y t~~~pRn`~d and subscribed before me this 5 day of J~ua ry ,~q 6? .
`''~tr~.•~...•.
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ROdER PORRAS
UERK IfCUIT COURT ~ Notary Public
gy tJ~G~~ , D.C. My ~ommisaion expires
(To b~ ~z~cuN~d in dupticat~ and ori~inal fil~d wiNe Cl~elc Gnuit Court, and dvpli~ah wilb Tax Ass~or.)
_ a~K 164 ~~~E 17Q
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