HomeMy WebLinkAbout0286 Oeclaratia~ ot Domicile and Citisenship -[617~ ~
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TO TNE STATE AND COUNTY TAX ASSESSOR.
51. lU(:tE ~OUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in aaorclance and
~n conformity with Chapte~ 2~3, Sectio~ 222.17, Florida Statutes.
I was formerly a legal ~esident of pikeville Kentucky
(City) (State)
and 1 resided at _ BOX 19? . Howaver I have chanyed my domiCile
(Street and Number)
ro and am and have been a bona fide resident of the Ststs of Fiorida sinoe 14~h day of
Noveaber , 14 67, end I reside at 1903 Binaeq Drive ~
(Streat and Numbsr) ~
,
fORT PIERCE, SAINT LUCiE CaUNiY, ~LORIDA `
a~~d this statement is to be taken as my decioration of citizenship, actusl legal residencs and domicile in the State of Horida.
(Insert here any pe~tinent facts, surti as sale of propery or business, or relinquishment of employmQnt ;
st former domicile, removal of family to new domicile, purchsse of home, etc.) #
a
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bntering R~~ona in the 5th grade
,
FILED AND RECORDED
ST. ~UCIE COUNTY. FLA.
COR[? t~~ :iFlrn
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- '61 ~lOV I S PM 2: 26
I C'• ~ - . ~ -~~~:~ZO
• ~CLERK CIRCUIT COURT
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i FURTHER CERTIFY that I will aomply with al) other requirements of a lefla) resident of this State. ~
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I fURTHER CERTIFY. that 1 have no intention to return to my former domitjle, and I intend to rema€n in FORT ~
;
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. . #
c.~ • ' ~
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(Naon~ ~
' ~ : ~G;:: ~ Bett Ann Little ~
:=Y `i: ~ ~ -
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. ~ = - (Address) f
,~$wocn~tv and subxribed before me this j~tb day of November 19~.Z.
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ROGER rORRAS
CIRCUIT COURT Notary Pvblic
g D.C. My Commission expiros
(To b~ ~uaM~d ie dupNcsl~ snd eri~in~l Al~d wi11~ ~Iwk Cirarit CovN, aed dupiicat~ wHl~ Tax Ass~s~or.)
~ a~x169 ~~E 282
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