HomeMy WebLinkAbout2458 Deciaratlo~ ot Don~lCile and Citisenship ~
f631U0 ~
TO THE STATE AND COUNTY TAX ASSESSOR. ;
~
51. IUCIE ~OUNTY, FLORIDA: j
Th~s is my declaration of Oomicile and Citizenship in the State~of fl'a~ida that t am filin~ this dey in acoorda~os and
~n conformity with Chapte~ 222, Section 222.17, Florida Statutes.
LaPorte Indiana
1 was formerly a legal ~esident of
(City) (Stsro)
1401 Illionis Street '
and 1 resided at Howev~r 1 have cfianged my domitile ~
(Street and Number) ~
21St t
ro and am a~d have been a bona fide residQnt of the State of florida since day of ~
~
749 Prima ~ista Blvd~ ;
l~C~ber , 19
6? , and 1 reside at
(Sheet and Number) ~
FORT PIERCE, SAINT tUCIE COUNTV, RORIDA
and this statement is to be taken as my declarotion of citizenship, actual legal residence and domitile in the Stats of Florida.
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchsse of home, etc.) .
~
1
Establishing residence
~~`Ep p~p RECORDEO~ . •
gT, 1.UC~ ~D ov~TF .
s~f co ~63100
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' , F ~ : ~U~~ ~OURT
I CLERK CIRCUIT
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I FURTHER CERTIFY that I will comply with al) other rtquirementa of a leyal resident of this State.
I FURTHER CERTIFY that I have no intention to retum t~ my former domiG~e, and 1 intend to remain in FORT :
PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently.
`~~:~iiltil:(; - : .
•U~ ('~i~ i~/ ~ .
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V~~ ='~J~~'~• ame) .
. , . . ~ - Harry ossert
y. J _
- -
~ - _ - ' . (Address) :
- ~./1~
~ ~ 29th December 67
Sworn to and subscribed before me this day of . 19 -
R POITRAS ~
CIRCUIT C RT , Notary Public ~
By ~t~'~~ D.C. My Commission expiras
Ro b~ ~x~cut~d in duplicab aed ori~inal fil~d whb Cl~rlc Urwit Cour~, aed dupliuh with Tax Ats~or.) ~
B~K169 ~A~~2440
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