HomeMy WebLinkAbout2710 Declaration ot Domicile and Citizenship
TO THE STATE AND ~OUNTY TAX ASSESSOR, ~~~G~i
51. UJCIE COUNTY, FLORIDA:
This is my declaration of Oomicile and Citizenship in the State of Florida that I am filing this day in atoo~dante and
~n conformily with Cfiapte~ 222, Section 222.17, Florida Statutes.
NeMland North Carolina
1 was formerly a legal ~esident of - '
(Ciy) (Stab)
Rt 1 . However I have changed my domiti~e
arxl 1 resided af _
(Street and Number)
to and am a~d have been a bona fide resident of the State of Florida since 17th _ day of
f
~lugust , ~q 67, a~ ~ reside at 1916 wyomina
Ave `
- (Sheet and Number)
FORT PIERCE, SAINT LUCIE GOUNTY, Rt3RIDA
and this statement is to be taken as my declaration of citizenship, actual legal reside~ce 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~LEO AND RECORDED
ST, ~V~~E COUNTY. Fl,q,
RECORD VERIFIEp
'68 JAN y AJy 163241 '
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CLERf( C~RCUIT COURT
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1 RIRTHER ~ERTIFY that I will oomply with all other requirements of a leyal resident of this State.
I FURTHER CERTIFY that I fiave no intention to return to my former domiti~e, and I intend to remain in FORT
PIERCE, SAINT LlK1E COUNTY, FLORIDA, permanently.
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, ~c~'~~tJ~~~' . 'c~GA~: -
- . . (Name)
_ ~ Yenneth D. Burleson
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Sworn to and subscribed before me this 4th day of Januarq ~~q 68 _
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ROGER PORRAS ~
CIRCUIT COURT Notary Public ~
gy ~-L D.C. My Commission expires -
(To b~ uc~eut~d in duplicat~ and ori~inal ~il~e! witb CINk Cirevif Cour~, ~nd duplieair whh Tax Ast~swr.)
~ 169 ~2~9i
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