HomeMy WebLinkAbout2688 Oeciaration ot Don~icils and Citise~ship 15325J
TO THE STATE ANO ~OUNTY TAX ASSESSOR,
51. IUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filirp this day in soo~rdsnoe and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of p~~
(Ciy) (State)
2612 Nol~'th Ave. . However I hsve cha m domidle
and I resided at - _ y ,
(St~eet and Number) j
to a~d am and have bee~ a bona fide resident of the State of Flo?ida sinee 22 dey ot
October tili 2612 North Ave.
_ , 19 , and I ~eside at
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual leqal residence and domicile in the Stab of Horlds.
(Insert he~e any pertinent fads, such aa sale of property or business, or relinquishment of employment
at forme~ domicile, removal of family to new domicile, purchase of home, etc.)
FII.zxc r~R xa~ES~r~?n ~os$s
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F~LEO AND RECORO D'
3T• ~U~IE COUMI'Y. l~,~; '
- RECORD VERIFIED ;
~`i '
'67 I~AR 6 PM I: 3 0 -
` ~.5325~
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j ~OGER ?'OITRAS
f CL£RK CIRCUIT COURT
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I RIRTHER CERTIFY that 1 will oomply with all ofher raquiremenh of a le~al resident of this State.
I FURTHER CERTIFY that 1 have no intention to retum to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
, ~
~
3
(Name)
_ ~NDR'EW J. B~AiIyiRER, Jr.
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~ • ,L~:,; (Address)
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'l~ ' , _rfi=~-:~~'a: ~ ~~..~v.-` • .
v f~ubscribed before me this day of . 19 67
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CLERK' CUIT COURT Notary Public
M mission ex ires ~
gy D.C. y Com p
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(To b~ ~x~cvtsd in dvplicat~ and ori~inal fil~d with Cl~k Grarit Cou~, and duplieab with Tax AsNaor.)
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