HomeMy WebLinkAbout0218 Oeci~ration ot Do~nicile and Citi:enship jsi6•3~3
TO THE STATE AND COUNTY TAX ASSESSOR. - ~
Sl. WCIE COUNTY, FIORIDA:
This is my decla~ation of Domicile and Citi=enship in th~ State of Florida that 1 am filin~ this day in acaordanoe a~d
i~ oonformity with Chapter 222, Section 242.17, Florida Statutes.
I was forme~ly a legal ~esident of Limestone idaine
(~ity) (State)
and ~ ~esided at _ Laring Air Porce BaSe . However i havscharpsd my domir3le
(Street and Numbe~)
to and am and have been a bons fide ~esident of the State of Florida since 16 day of
June , 19 66~ and I restde ar ~ 364 Ba~-raclough Street
(Street and Number)`
fORT MERCE. SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my dedaration of citizenship, dctual legal residenoe and domicile in the State of Horida.
(insert he~e any pertinent facts, such as sale of property or busi~eu, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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Bstablishing residence F~~p /?~iD Rf
ST.I.UCIE C0U • ~
~ RECOR6 VERIR{~ ~ ~
. _ 151638
- '6T JAN~ 6 PN l2:23 _
R~OG~R f'OITftAS ~
CLERK CIRCUIT COURT
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I FURTHER C'HtTIFY that I will oomply with all other roquiremenfs of a le~al restdent of this Stste.
I FURTHER CERTIFY that I have no intention to retum to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT WCIE COUNTY, FLORIDA, permanently.
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: ,,~;~:~t~.,:,.` _ s
:i~~~::'-~ - ' (Name) ,
, J . . " _ ' ~ . .
f ' - .
' ~ . James L.Davis by Agnes V. Da~vis
~ _~;n ~ ` _ ' ~~t~ ' th~~~Pow¢ Attorne
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~t' ,S ~~'subsuibed before me this 6 day of Tanuarp 19 6?
.
•°,rf'.,., r -
ROGER ~OITRAS
- q~K C~ CpV~ Notary Public
gy D.C. My Commission expires
(Te b~ ~x~aM~d in dupiicat~ and oei~inal Nl~d wila Cl~eic Cinui! Carrf, and dupli~ah-wilh Tax A~saaor.)
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