HomeMy WebLinkAbout0945 O~claratlon nt Do~niclf~ sfld Citlxenship
TO TME STATE AND COIfNTY TAX ASSESSOR. ~ 3f212p
Sl. LlJC1E COUNIY. FLORIDA:
This is my decla~ation of Oomicile and Citizenship in th~ State af Florida th~t I am filinq this day in aooo~dano~ and
~n conform;ty with Chapter 222, Section ?2?.17, Fiorida Statutes.
1 wss fotmerly a legal residant of podPtan Plaias Mew .Tersey
, Kiy} (Sta»)
. ~
and 1 ~esided at 8 peC~ Ave. . Hov„ever 1 have chsn~sd my domidle
(Snaef and Numba~) ~
ro and am and have been a bona fide ~esides~t of the State of Florida since 7tb day of ~
P ;
Se tember , ~q67 , a~d t teside at 16? Lucero Drive ( Port St. Luci~ ) ;
. ,
(Street and Number)
~ORT PI~tCE, SAINT lUC1E COUNTY. RORIDA
and this statement is to be taken as my daclaration of citizenship, actusl le9al residence and domidle in the Staro of Florida.
(Insen he~e any pertinent facts, such as sale of proparty or busineu, or ~elinquishment of employment ~
at former domicile. removal of family to new domicile, purchase of home, etc.)
$stablishing ressdence
$T•~
C E CQUNTY
FL~;, .
COP,D VERIFIED
~~1~ '
• ~ '67 NOY 2~ P!I I; s
.
' ~ ~~oc~a ao~rR4s
CtERK CIRCUIT COURT
I RJR7HER CERTIFY that 1 wiil aomply witfi all other requiremenri of a leyal resident of this Sfate. ;
. ~
I FURTHER CERTIFY that 1 have no intention to retur~ Lo my former domic,ile, and I i~tend to remain in FORT i
PIERCE, SAINT tUCIE COUNTY, FLORIDA, permanently. ~
. ...~j:::f, ' s
n ~ .,j~, t
~ b {i / - 1f~ ~
= • . ~ 1 . (Name) .
• i~J ~ : _ ~ ` • J . ~
_ ~ = o': ~ Alf red' G. Bailey `
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• ~ ~f . _ - ~ ~ ~ ~ _ li/~~ W ~ ~3/ ~
_ . ' ~ y~.°~ 1.~~• B821ly ~
- _ ' ~ `i
'~~~'viiain ~~at+~~`subscribed before me thls 28th da of ~vember 19 67 `
.•t~ y ~
RQGER ~OIT~AS
CIRCUR Notary Public
a~..~~-
BY D.C. My ~ommiuion expires - •
Ro b~ ~x~arhd jn duplieah and oei~inal A{~d wilh Cl~rlc tirait Cowt, and dvplkat~ wi~h Tax Aa~aor.)
LOOK P1~f
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