HomeMy WebLinkAbout0270 ~eclaratlo~ ot Domicil~ ~~nd Citisenship ~
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TO THE STATE AND COUNTY TAX AwiSESSOR, t
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Sl. lUC1E COUNTY, FlOR1~A: • • i
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This is my declaratio~ of Domicile and Citisenship in ths State of Florida that 1 am fJi~q this dsy in aooord~no~ and
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in conformity with Chapter 222, Section 222.17, Florida Statut~s. ~ ~
1 was forme~ly a legal resident of Bt3Ck TOM11 NCM ~jerSel?
. (City) (Stah)
and I resided at 304 Cherry Quay Rosd ,~WevK I have chan~d my domWle
- (Street and Numbe~)
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to and am and have been a bona fide rosident of the State of Florida sinos Ju ly d~y ~ j
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- lst , 19 b~, a~ ~~i~ n R 4 Box 354 McNei~ Ro~d
(Street end Number) ~
~ORT r1ERCE, SAINT LUCIE COUNTY, RORIOA
anc3 this :tatament is to be taken as my decisration of citizenship, actual le~al rssidenos snd domidls in fhe StaM of Florida.
,
pnsert here any pertinent fact:, such as sale of property or bu:iness, or rolinquishment of employrnMt
at former domicile, removal of family to new ~domicile, purchass of home, etc.).
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Bntering Allea in the lst grade
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. ~~LEO AND RECOYOF~, i
- gT,1.UC1E COU1'IT • ~
REC~RO vERIF1E0 . ~
.159'7~ : 58 ~ ~
~61 SEP 5 ~ . f
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4 ROGE=R ~'O?TRAS ' ~
~ . CI.ERK CIRCU17 COURT
1 FURTHER CEitTIFY that 1 will aomply with all otF~ roquiromentt of a le~al rosldent of this Stste.
I FURTHER CERTIFY that I have no intention to retum to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT lUC1E COUNTIf, FLORIDA, permanently.
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~ a ~ Bva Ta loa ( Mrs Horace )
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~:~~ll~rr~,ahd subscribsd before me this Stb ~y of Septesber , 19 67
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ROOER 'OITRAS
CtRCUIT COt~T 1 Notary Publk
gy ~ D.C. My Commiuion expires
(Te b~ ~uar~ad in d~plicah aad ori~inal H1~d vrMb Cl~k Cie~a~it Ceu~l, aed d~plkaN wilb Tax Aw~a
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