HomeMy WebLinkAbout1261 oec~aration ot Domi~ile a~d Citizenshlp 152343
TO THE STATE AN~ ~OUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FIORIDA: ~
This is my declaration of Oomicile and Citizenship in ths State of Florida that I am filing this day in aooordance and
in conformity with Chapte~ 222, Section 222.17, Florida Statutes.
I was formerly a legal ~esident of New Ci t y New Yo rk
(City) (Sta»)
, ,
and 1 resided at 4 RadC lif f Drive . Howevaf I have chsn9ed my domivl~
(Street and Number)
to and am and have been a bona fide reside~t of the Stste of Florida since 2 8th day of
December , ~q 66, a~ ~i~ at St Benidict Road ;
(Streef and Number) i
FORT PIERCE, SAINT LUCIE COUNTY, aORIDA
and this statement is to be taken as my declaration of citizenship, attvallaQalusidence and domitile in the State of Hotida.
pnsert here any pertinent facts, such as sale of propeny or business, or relinquishment of employmsnt
at former domicile, removal of family to ~ew domicile, purthase of home, etc.)
Establishing residence
~ro a~ D~.
sT. ~ucr~ cou
~~~u.;
RE~ORO VERtFl~O
152343
'f '6t JAM 3I AM 10: q~
I D~~~
IRBGER r'OITR 9
a~aK cutcu~T co~~
1 FURTHER CERTIFY that I will aomply with all other requirements of a lepal resident of this Stete. ~
. ;
1 FURTHER CERTIFY that 1 have no intention to retum to my fo~mer domicjle, and I. intend to remain in FORT =
RIER~('r;~~~' NT~L~L~~COUNTY, FLORIDA, permanently.
: , . _ .
, yj.),.r.•fCC':,i'
: ;~...i i ' ~ V ~ ~ i
_ Y:~; ~ _ (Name)
' - -Y:_: ' ~ = J ames C Campbe 11
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~I~--• f ~ t:
~(~~,'`~v '~C - (Address)
.
Sworn to and subscribed before me this 31 S t day of T an au r y q 6 7,
ROGER rO1TRAS
CIERK CIRCUIT COi~RT - Notary Public
~ ~ `~z~G,~,C. ~
gy- ~ D.C. My Commiuion expires
(fo b~ ~ac~aiNd in s~plicsb an~ ori~insl Rl~d with CMelc Cira~it Couet, and dupllcN~ wjtl~ Tax A~or.)
e~cl~
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