HomeMy WebLinkAbout2634 Declaration of Domicile and Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR. ~63Z94
51. WCIE COUNTY, FLORIDA:
This is my declaration of Domicile a~d ~itizenship in the State of Florida that 1 am filir~g this day in acco~dance and
~n confo~mity with Chapter 222, Section 222.17. Florida Statufes. ~
t
I was formerly a legal res~dent of Norwalt Conn. _ ~
(City) (Stafe) !
and 1 resided at 270 _ _F11101M _ Street _ _ _ _ _ _ _ ~„rever I have changed my domitile !
(Street and Number) ~
to and am and have been a bona fide resident of the State of Florida since _---gth day of
!
67 . 180 Bton Drive Port St. Lucie
~pril ~9____, and I res~de at
- - - - - - - - - (Street and Number) - - - -
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA ~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(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.)
Establishing residence
F~~EO AND r~ECOROED
S7. .LUCIF .COy~',~~Y. FI..A.
H.EF~~~i; ~l' ril€r~p
. ~63194
2 P~1 ~ : 33
~ ,~o,~.~
• 1 :,1~. :
, CL~RK CIRC(}IT COt~K~
i ~
1 FURTHER CERTIFlf that I will comply with all other requirements of a legal resident of this State. '
I FURTHER CERTIFY that I have no intention to return to my former domic,ile, and I intend to remain in FORT
PIERCE, SAf(~T- LUCIE COUNTY, FLORIDA, permanently.
-
' ~ ' ~ (Name)
. , -
: ~ Catherine Zei r
U% _ . '
- ; . -
' ~ (Address)
.
. - .
- : : v~.t..:
an , 19 68
Sworn`to and subxribed before me this 2nd day of `j •
ROGER POITRAS
CIRCUIT COURT Plotary Public
gy ~~~r~ D.C. My Commission expires ~
.
_ ~
(To b~ ~xesut~d in duplicsh and ori~inal filed with qKic Grcuit Court, and duplicat~ with Tax Ass~ssor.) ~
~~K 169 PA~~ 261.5 ~
„ - - - -