HomeMy WebLinkAbout1181 O~claration of Domicil~ a~~ Citisenship `l$~~~
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TO THE STATE AND ~OUNTY TAX ASSESSOR, .
51. LUCIE COUNTY, FLORIDA:
This is my daclaration of Domicile and Citizenship in the Statc af Florida that 1 am filinq this day in aooorda~ct and
in aonformiy with Chapter 222, Section 222.17, Fbrida Statu»s.
I was formerly a leyal ~esident of KO~~ NeM~ Sork
(Ciry) . (Sta»)
snd I resided at R D~ 1 Hcw~ver ! hav~ chan~sd my domicl~~
(SKset and Number) ~
ro and am snd have been a bone fide ~esident of the Stah of Florida :inos, , dey of
.rs~„~.•o , 19~, and I resid~ at ~5~ ~t~va ~vs
(Shest and NumbK)
FORT r1ERCE, SAINT LUCIE COUNTY, RORI~A
and this statement i~'~o be taken as my detis~ation of citizenship, sctual legal residenoe and domidle in the State of Horida.
(Insen here any pe~tinent facts, such as sale of property or business, or rolinquishment of employrrwnt
st former domicile, removal of family to new domicile, purchase of home, etc.)
~
~t?tering . children in $le~neatary achool -
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RECAR~~
- FII.E~ AND TY'.,
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CLER
I FURTHER CfRTiFY that i will aomply with all othsr raquirerr~snts of a lepai resideM of this State. .
1 fURTHER CERTIFY that I have no intention to retum to my former domicjle, and I intend to remain in FORT
PIERCE,. SqCN'Z~ W/f31~ COUNTY, FLORIDA, permanently.
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Sworn to and subscribed before me this 3~ day of Jaaaury , 19 67. ~
ROGER ~OITRAS -
~~R Notary Public
_~~c. "rt~ .
gy D.C. My Commiuion expires
(To b~ ~x~evl~d iA duplicah and ori~nal A{~d wilb Cl~rk Cira~it Coe~1, and ~plk~t+ wilb Tax A~or
)
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