HomeMy WebLinkAbout0149 , Dealaratio~ ot Domiail~ ar~d Cltis~nship ~
TO THE STATE ANQ COUNTY TAX ASSESSOR, , la~s
51. LUCIE COUNTY, FLORID/0.: ~
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This +s my declaration of Domicile and Ctimnship In ths Stero of Florida that I am filin~ thi: day in aooordano~ and
~n aonfo~mity with Chapter 222, Section 222.17, Florida Statutes.
1 was formeriy a lega) resident of ~1~~
(CitY) (Sta»)
and 1 re:idad at Baot ~5 North Pole .~,~ver i havs chan~ed my domidle
~Stroet ar?d Numbsr)
to and am and have t~een a bona fide resident of the State of Fbrida sinos ~t ~y
Jnr1e , 14,~~, and 1 roside at ~1- I~Ia L9th St,reet ~ Lat. ~ 7&~S~o Rd .
(Stroet and Number)
FORT MQCE, SAINT LUCIE COUNTY, ROR~A
and this statement is to be taken as my dedaration of atizanship, adusl le~al residsnos and domicile in the State of Hotlda.
(lnsert here any pert;nent facts, such as sale of propsrty or business, or rolinquishment of smploym~nt
at former domicile, renaval of family to nsw domicile, purchese of home, etc.)
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,
~htering Larry Allen iiilliaiss in the 5th grade ~
M ~
, Bdgar Les Desl in the 7th grade
--..s.-.:. . .
ST~UC ENp RE~p~O .
pECORD V~RIFYED~.
~r auc 3?~s~~s
~ iz: 3 r
- ~
CLERKJ~~ r~ortRhs I
C~RCUf T COURT ~
i FURTHER CERTiFY that i will wHfi dl . ~
comply other requirements of a lepa! resident of fhk State.
! FURTHER CERTIFY that I have no intention to retum b my former domicjle, and I inte~d to remain in FORT
PlERCE, SA1NT WCIE COUNTY, FLORIDA, perma~entiy.
~..~~N,rt:r ~ ~ . r ' -
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- ` • ••w•~' ~f t ~ i704Vy ^1~1~Q~~~rs Marion J• . . 1~Y48,
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•'!Swio?n?td'~nd wbsuibed before me this 31at A ugust ~q 67
Y .
ROG~ ~ORRAS . .
C~CUR COURT . Notary Publit
BY D.C. My Commission expires ~
~
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Re b~ ~oncvhd in drplicaN a~wl o~iaiRal f~Md wilh CM~k Circvit Cowi, aad dupiicM~ whh Tax A~.1.
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~~168 ~ 149 ~
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