HomeMy WebLinkAbout2174 oeclar~tion ot Domicile and Cltisenship 1591i4
TO THE STATE AND COUNTY TAX ASSESSOR,
Si. lUC1E COUNTY, FIORIDA: ;
This is my declaratior~ c~f Oomicile and Citizenship ln the State of Florida th~t 1 am filin~ this day in scoo~dano~ and
in oonformity with Chapter 222, Section 222.17, Ftorida Statutes.
i was forme~ly a legal residsnt of Auati.n Te7[as
(Ciy) (Sta»)
and 1 resided at 1~~ ~e~ ~~t . Howevsr 1 have char~yad my domtc,ile
(Straet ancf Number)
ro and am and heve been a bona fide ~es+dent of the State of Florida sinoe ?th day of
~
" J~Y , 19~, and I resids at 348 Dundas Cottrt
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is. to be taken as my declarafion af citizenship, ach,el le9al ~esidence and dorr~iclle in the State of Horlda.
(Insert here any pertinent facts, such as :ale of property or buainess, or relinquishment of employment
at former domicils, removal of family to new domicile, purchase of home, etc.)
Derrick
Entering ~n¢ Livingston Jackaop in lst Grade
` FILEO AND RECOROEO
ST. LUCIE COUNTY. FLA.
~E 15911-4 0
• 9 ~
'67 AUG I5. AN • ~ .
-~Q.
~oc~:.R ~ Oi i RaS f
~LERK CiRCU1T 60URT
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1 FURTHER CERTIFY thst 1 wiH oomply with a!I other requiraments of a IeDsl resFdent of thts State. ~
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1 FURTHER CERTIFY thas I have no intention to retum to my former domicjle, and I intend to remain in FORT ~
~
PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently. ~
, ~
(Name) ~
Hre. Catheriaa JaCkaon i
~
(~?ddress) ~
';I.• . - • i v`, ~
~
' ,.S~iirorn:to.srW subsuibed before me this 15~ day of A~igvat , 19~._.
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- _ . n.
ROGER. ~RAS
CIERK Ci~l31JiT` COURT Notary Publit
g"•. - -
Y. ~.C. My Commistion expires
; •~~~:~tti=' ' .
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lTo b~ ~acK~d ie d~plicata and ori~ieal fi{~d w~h Cl~ek qraik Cou~t, aed dvp~ wilh Tax A~o~a
~=_:1S'~ ;h~2~.74
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