HomeMy WebLinkAbout2690 DeClaration ot Domicile and Citizenship 163?~2'~'
TO THE STATE AND COUNTY TAX ASSESSOR, i
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Sl. LUCIE COUNTY, FLORI~A: t
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This is my declarotion of Domicile and Citizenship i~ the State of Florida t~at 1 am filing this day in actordance and
in conformity with Chapter ~22, Settion 222.17, florida Statutes.
1 was fo~merly a legal resident of DUbQiS__ _ _ _ penO• _
(Ciy) (Staro)
111 V a l le q Awe. . However I have chan m domicile
and I resided at - - - - - 8~ Y
(Street and Numbe~)
ro and am and have been a bona fide resident of the State of Florida since -2Bxh-- day of
November 6? 3806 Ave N
- . 19 and I reside at _ -
- (St~eet and Number)
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FORT PIERCE, SAINT LUCIE COUNTY, RORIOA ~
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and this statement is to be taken as my declaration of citizenship, adual lega! residence and domicile in the State of Ho~ida. .
(Insert here any pertinent fads, such as sale of prope?ty or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchasc of home, etc.)
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Establishing residence ST ~EO ANO RECOROED
IUCIE COUNTy~ F~A.
RECQRp VERlFIEO
'68 JAN 31s3~'~'
. AM II:58 ~
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F.o~E~ ~-oitR~S~ ~
CLERK CIRCUIT COURT ;
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I RJRTHER CERTIFY that ! will oomply with all other requirements of a legal resident of this State. ~
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1 FURTHER CERTIFY that I have no intention to retum to my former domiCile, and I intend to remain in FORT ;
PIERCE, SAINT. ~tUG~'j; COUNTY, FLORIDA, permanently. ;
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_ ?t.S L' X • ^ ~ i
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- - (Name) ~
- - " ~ = Frank Lavel2a `
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% _ (Address) ~
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Sworn to and subscribed before me this 3rd day of January ~ 19 68 ~
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ROGER PORRAS ~
CIRCUIT COURT Notary Public ~
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gy Q'`'~'~ D.C. My ~ommission expires t
(To !r~ ~x~cuhd in dupliut~ aed oripinal fil~d witb CIKic Cj~uit Cour~, and dupliuta with Tax As~ssor.)
BC~K ~~~7 PdCt ~G6 71 i
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