HomeMy WebLinkAbout2631 Declaratian ot Dort~icile and Citisenshlp 1g3191 i
TO THE STATE AND COUNTY TAX ASSESSOR.
Sl. IUCIE COUNTY, FlOR1~A:
This is my declaration of Domicile and ~itizenship in the State of Florida that I am filing this day in accordance and
~n conformity with Chapter 222, Section 242.17. Ftorida Statutes.
1 was forme~ly a legal resident of ._B81pbi1~C ~~'Q ~~a i
1
(City) (S1ate) ~
16 24 UO t h e?Q RO ad However I have cha ed m domitile
and I ~esided at - - ~9 Y
(St~eet and Numbe~)
to and am a~d have beer a bona fide resident of the State of Florida since ________16th_ day of
19 , and I reside at 1824 Jo 34th street
_ ~tober b? _ -
(Street and Number) ~
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA ~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
1
s
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment '
at former domicile, removal of family to new domicile, purchase of home, etc.) ~
;
F~LED AND RECORD
ST, 111C~E COUfyTy E~ _
RFCORp t'ER! pLA. ~ -
, ~~3i ~
.~stablishing residence 68 JAN 2 P~ - 2~ `9-Z
33 ;
• i
CLE~tO:;i:'r 'OlTr?,t,g ~
R?c c~RCV?r couRr ~
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_ ~
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I FURTHER ~ERTIFY that I will oomply witfi all other requirements of a(egal resident of this State.
1 FURTHER CERTIFY that I have no intention to return to my former domiti~e, and 1 intend to remain in FORT
PIERCE, SAINT I.UCIE COUNTY, FLORIDA, permanently.
, ~ . ~ .
- ~ (Name)
- , :
, •
' " ohn H. Fox
.
_ .
- - ~ - (Address)
. . . ~ :
. , 2nd J anuary 68 _ _
Sworn to-arid subsuibed before me this day of . 19 •
ROGER POITRAS .
CIRCUIT CO RT Notary Public
~
gy °t'``~'~- D.C. My Commission expires
(To b~ ~x~cutad in duplicah and ori~insl fil~d with ~tKlc Urarit Cou~, and dupliem with Tax Ass~ssor.) ;
. aa~K 169 ~acc 26~ !
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No. 13 .