HomeMy WebLinkAbout2341 Decia~ation ot Domicile and Citisenship
.153U14
t0 THE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FIORIDA:
This is my dectarotion of Domicile and Citizenship in ths State of Flo~ida thst I am filing this day in aoco~dance and
in conformity with Chapte~ 222, Section 222.17, Florida Statutes.
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I was formerly a legal residenr of Shinnston WPCt V+ rvi n18
~~ify~ (Stste)
end I resided at _ 1208 E• p~Pe Street . Howevef I have chan9ed my domicile
. (Street and Number)
to and am and have been a bona fide ~esident of the State of florida since lst day of
July xir4 66 Route 2 Box 4308
_ . , 19 , and I reside at
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, fLOR1DA
and this statement is to be taken as my declarotion of citizenship, actual legal re:idencs snd domicile in the State of Horida.
(Insert here any pe~tinent facts, such as aale of propery or buaineu, or ~elinqui:hment of employment
at former domicile, removal of family to new domicile, purchase of iwme, etc.)
~ ST.LL
C EN C UNTY~
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Establishin~ residence RE~ppp yERIF1ED
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6l fEB 21 ~Iy I I: 3q
~53~14
f'cO~CR r OITR;,S
CLERK CIRCUIT COURT
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I FURTHER CERTIFY that I will oomply with all other requirements of a leqal resident of this State.
I FURTHER CERTIFY that 1 have no intention to retum to my former domiCile, and 1 intend to remain in FORT
PIERCE. S/~INT-_ IU~tE COUNTY, FLORIDA, permanently.
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4 Harold Shaffer
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Sworn to and subsuibed before me this _ 2 7 day of F e b r La r v , 19 6 7. #
ROGER POfTRAS
CLERK CI UR COURT Notary Public
gy D.C. My Gommission expires
(To b~ ~x~cut~d In duplicat~ and ori~insl Al~d with CINIc Cirwit Couet, ~nd dupllcat~ with Tax Asws~or.)
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