HomeMy WebLinkAbout2701 Declaration ot Domicil~ and Citizenship
" 163236
TO THE STATE AND COUNTY TAX ASSESSOR.
51. tUCIE COUNTY, FIORIDA:
This is my decla~ation of Domicile and Citizenship in the State of Florida that 1 am filing this day in actordance and
~n conformity with Chapter 222, Section ?22.17, Florida Statutes.
I was formeriy a lega! ~es~de~t-of ___-__Middleothan _ I11. _
~C;~y~ (State) ~
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13209 St. C1aiI . However 1 have cha m domiCilc t
and I resided at ~9~ Y
(Street and Number) ~
to and am and have been a bona fide resident of the State of Florida since -_211d _ day of ~
June 67 1004 Coloniai Drive
_ _ _ _ - _ ~ 19 and 1 reside at
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA '
and this statement is to be taken as my declaration of citizenship, aduat legal residence and domicile in the State of Horida.
(Insert here any pertinent fads, such as sale of property or business, or telinquishment of employment ;
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at former domicile, removal of family to new domicife, purchase of home, etc.)
Establishing residence FILED AND RECORDED
ST. LUCIE COUNTY. FLA.
H~CORD VERIFIED
'~8 JAN 3 pM 163236
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' CLERK CIRCUIT COURT ~
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1 RIRTHER CERTIFY that I will aomply with all other requiremenis of a legal resident of this State. ;
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1 FURTHER CERT!FY that I have no intention to return to my former domitile, and I intend to remain in FORT ;
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. #
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. ~ -Fr~~~~-- °
. . y, J , ~ (Name) _ ~ }
- Ossa E. Shaffer ~
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- 3rd Januaiy , t9 68. _
Sworn,,tp'a~d wbxribed before me this day of '
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ROGER POITRAS ~
GiRCVIT COU . Notary Public ~
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gy ~.C. My Commission expires #
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(Te b~ ~x~cut~d in duplicat~ and oripinal fil~d witb Cl~rk CuarH rf, and dupliut~ with Tax Ass~swr.)
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