HomeMy WebLinkAbout1198 ~ 1523Q4
D~cluration ot Domicfl• and Citisenship
TO THE STATE AN~ GOUNTY TAX ASSESSOR, . ~
Sj. LUCIE GOUNTY, FLORIDA:
This is my declaration of ~omicile and Citi~enship in the Ststa of Flaida that 1 am filin~ thl: day in aooordanoa ~nd ~
in oonformity with ~hapter 222. Section 222.17, Florida Statut~s.
I was formerly a leqal resident of J~aC3Q1 MI~.
(Ciy) (Stat~)
end I resided at ~9 ~°r 3t. ~ Rivea Junction ,~,~,rK ~ have d~anqed my domidle
(Strvet and Numbe~)
to and am end have been a bona fide resident of the State of Florida tinos 5~ ~Y ~
Novembelr~ , 19 and I ~eside at 3~ 0
(Street and Number)
l~ORT MERCE, SAINT LtICIE COUNTY, RORIDA ~ _
and this statement is to be taken as my declarotion of citizenship, actual leya) residsnoe and domicile in the SYaM of Horida.
m~nt ~
(I~sen here any pertinent facts, such as sale of property or bu:iness, or reltnquishm~nt of employ
at former domicile, removal of family to new domicile, purthase of home, ett.)
FILING FOR HQ~ISSTSJID PU~3S3 ~
~it.EO 11NQ flE 0:
ST. LUCtE COUNTYe~• `
AECOR~ VERtR1~D -
1.52;3Q4 -
~ '6t JA~I 30 PM 12 : I2
ROGER POITRA8
- CLERK CIiiCUtT COUl~T"
,I
~
i FURTHER ~fRTIFY that 1 wiil oom~ly with ail othsr roquirsrnsnts of a lepai residsnt ~thls State.
I FURTHER CERTIFY that I have no intention to retum to my former domi~ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~ ~ (Name) .
_ ~t~'`~~'~u,ut'j'1~, iiILF~D I+I. DODGB
.t` V~~ CO~j'~~
~1~~~~ 4V r~~ ~ G/~.~i ~
= y
°V~~hJ~ ~~r•~~,'
- : r ~'~'~i ~ ~S~ : ~ ~ _
' ~ ; ~ !~~~~~~..r c~s = l~iaiy S. Dodgs
.'~~;~i - . ~ .
' : ~ ~'t 3~ Jann~ai9 19 67
, tl~'~~'~~;~ wbsuibed before me this day of - •
' '•'.,~=?i~w~;~S'";.•~~ 1. .
~ ' . ~t: " ~ 1
U~~~~H~~~ '
C ( ~_~+r,~~~~ -
''~r 144i1~~ -
Notary Publis
~
gy D.C. My Gommission expires
(Te b~ ~x~evl~d is dupNadr and o~i~ind fU~d wilh Cl~elc pn~h Cowf, and dupika~l~ wilh Tax Asw~x.1
~ ~164 ~i,19'l
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