HomeMy WebLinkAbout2686 ~ Oecla~ation ot Domtcile aMd Cnizenship
. 153~25'7
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FIORIDA:
This is my declaration of Domicile and Gitisenship in the State of Florida that 1 am filin~ this day in aooordanos a~d
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~n conformity with Chapter 222, Section 2Z2.17, Florida Statutes. , ~
Milville New Tersep _ ~
I was formerly a legal ~esident of
(City) (S1at~)
R..F.D.~2
and I resided at - . However 1 have chsn~ed my domidle
(Street and Numbe~) ~
10
to and am and have been a bona fide resident of the Staro of Florida since d~Y ~
November 66
_ _ , t9 , and t reside at 1222 Raymond Avenue
(Street and Numbsr)
FORT PIERCE, SAIN? LUCIE COUNTY, FLORIDA I
and this statament is to be taken as my declaration of citizenship, actual leyal residencs and domicile in the State of Norida. i
Insert here an ~tinent facts, such a: sale of ro or business, or relinquishment of employment ~
( Y P~ P PQ~Y ~
at forme~ domicile, removal of family to new domicile, purchase of home, etc.)
F~~ED AND RECORDED
ST.RECO'Rp VERfF1~F~' ~
Bsta blishing residence D
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+~QGLF' i U1TR:,g
CLERK CIRCUfT COURT
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1 RIRTHER CERTIFY that I will comply with all other rsquiremenfs of a le~al residsnt of ihis State. ~
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~ I FURTHER CERTIFY that I have no intention to return to rmer d9micjle and o emain in FORT ~
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PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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_ :~.~;`'t:~ (N ~
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I ;z~ - Franklin W. Thtal ~
~ . . ..~a ~ fr.:
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~ ~r~ro~.~o~~.~uDsuibed before me this _ day of . 19 -
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ROGER lORRAS
_ ~p~~ Notary Public
gy ~ J D.C. My Commission expires ~
~ ~--(To b~ ~x~eul~d in dvpNeab anel orianal fil~d wilh Cl~eic qrwi! Cour~, and duplieah wifh Tax Aa~or.) ,
_ 6~K 164 PACi ~
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