HomeMy WebLinkAbout0262 Deciaration ot Domicil• ~and Citisenship ~ ~59'?'~0 ~
TO THE STATE AND COUNTY TAX ASSESSOR, .
Si. LUCIE COUNTY, FLORIDA:
This is my declaration of Oomicile and Citizenship in ths Stat~ of Florid~ that I am filin~ this day in acoorda~a and
in aonformity with Chapter 2Z2, Ssctio~ 222.17, Florida Statut~s.
1 was formerly a le9al ~esida,t of Villaae (i~en Park. I~edia~ Penn841vania
, tCiy) (Sta»)
end 1 resided at i59 ~t~.h ~venue , HovwvK I hav~ chuped my domkile
(Street and Numbe~)
ro and am and have been a bona fide r~ident of the Staro of Florida sinoe ~-h - daY ~ ' ~
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_ wt~uat , 19~Z, and I naide at 323 ~ bemnard Stree~ ~
(Street end Number)
L COUNTY RORIDA ~
FORT ~IERCE, SAINT tlCIE . f
and this statement i3 b be taken as my dedar~flon of citiztnship, actual IeQal residenoe and domicile in the Stat~ a~Florids. ;
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pnsert here any pertinent facts, such as ~le of propsrty or bu:iness, or miinquishm~t of employment
at fotmsr domicile, nmoval of family to new domiale, purchase of homs, etc.)
Establieh ~a3dency FILEO AND RECOROED
ST. LUCIE COUNTY. ~LA.
RECORD VERIFIED ~
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. '61 SEP 5 AN II: OS
' 159`?`s0
n0v~~a t O~TRaS .
CLERK CIRCUIT COURT
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~ 1 FURTHER CERTIFY that 1 wili aomply wNh all othsr requiraments of a lepsl r~ident of this State.
I FURTHER CERTIFY that 1 have no intention ro return to my fomner domi4le, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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(Name) -
Balph L. i~TTalters
(Address)
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Sworn to and wbsaibsd before me this Kth - day of Sevtembel' , 14~_.
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- _ , , R06E~: l~A~ .
. mR1~C1~CINT L01lRT Notary Public
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~ ' D.C. My Gommission expires
gY ,
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Ro, b~ ioc~svNd M dupikae~ and orioinal fiNd wilh Cl~ek Ci`cuh Ce~e~, and dup~ whb Taoc As~~a.)
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