HomeMy WebLinkAbout2218 i62961
Decla~ation ot Domicile and Cit~zenship
TO THE STATE ANO COUNTY TAX ASSESSOR. ~
51. lUC1E ~OUNTY. FIORIDA: ~
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This is my declaration of Oomicite and Citizen;hip in the State of Florida that 1 am filing this day in atoordanoe and
~n conformity with Chapter 222, Section 2~2.17, Flofida Statutes.
Arlington Vir ginia
1 was formerly a legel residmnt of -
(Ciy) (State)
and I ~esided at 5122_ NOrth 25'Lh R08d However 1 have changed my domitile
(St~eet and Number) '
~
?o ~nd am and have been a bona fide resident of the State of Florida since z6th _ day of ;
;
_ Deceober . ~Q , a~ i reside at Route #2, Boa 5820, Lakewood Park :
_ ,
(Street and Number) ;
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, adual legal residence and domicile in the State of Horida.
(Insert here any pe~tinent facts, suth as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
ESTABLISH RBSIDBNCB
Fq.ED AND RE~AR~~~
ST. lUC1E COUNTY. FLA. ~
R~.CORn VERIFI~ ;
~
i
'67 OEC 2~ AM ~ ~ ~ 3 ~ ~
162961 ~
~ •.i: .i:_ . "r U; ; i::.J
~ CLERiC CIRCUIT COURT .
~ 1 FURTHER CERTIFY that I will comply with all other requirements of a(e~al resident of this State.
I FURTHER CERTIFY that 1 have no intention to return to my former domic.ile, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~..Je~--
(Name) S. DOdd
Rt, ~2, Box 5820, Lakewood Park
(Address)
7th December 67
Sworn to and subscribed before m~;tktier'~ day of , 19
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ROGER rO1TRAS ~ C~ r_ w'
CIRCU OURT _ E- n_ Notary Public
' • ~r-i. t., _ ,J_'C) -
gy - D.C; My Commiuion expires
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(To b~ ~x~evt~d in dvplicaf~ snd'ort~iwsl.fif~ witb Cl~elc Cirwit Court, and duplicat~ with Tax Ass~ssor.)
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