HomeMy WebLinkAbout2713 Declaration ot Domi~ile a~d Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR. 16~44 ~
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51. LUCIE COUNTY, FIORI~A: ~
hi i m declaration of Domicile a~d ~itizenshi in the State of Florida that 1 am filing this day in attordance a~d ~
T s s y P ~
in conformity with Chapter 222, Section 222.17, Flo~ida Statutes. ;
I was forme~ly a lega) res~denr of BaltiuOre _ 1~larvland
~C;y~ (State) i
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and I resided at _ 5325_ 1NlSeDll--A~tG~-i- However I have changed my domicjle ~
(Street and Number) ~
to and am and have been a bo~a fide resident of the State of Florida since -~2nd day of ~
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4751 San ~iago Ave. ~
_`Sg~tember , 19~~, and I reside 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 Horida. ,
(Insert here any pertinertt facts, such as sale of properry or business, or relinquishment of employme~t
at fo~mer domicile, removal of family to new domicile, purchase of home, etc.)
Establishing residence
FILED AN~ RECORDED
ST. LUCIE COUNTY. FLA.
RF GO?f? V~RIFIEO
16~4 ~
, ~ '68 JAN 4 AM 10 : 28 ~
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:.pvL , -',7iTri :S ~
'I CLERK CtRCU1T COURT
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1 FURTHER CERTIFY that 1 will oomply with all other requirements of a legal resident of this State. }
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1 FURTHER CERTIFY that t have no intention to return to my former domic~le, and I intend to remain in FORT ~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. - ~
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i~:~.~~- ame)
- ; _ ~~-L Henry rey
_'t`~ - : ~ ~.:~r ~ ~
sti• , ~ ~ - . ~ i~ic~i~esk
- '0 Bertha N. Frey ,
~r r.E ` 4th anuar ~q 68
~~5wtxn'fo~and subscribed before me this day of J p~ . ,
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ROGER POITRAS '
CIRCUIT COURT Notary Public ;
~,ct~ ~
gy D.C. My ~ommission expires ~
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~ Ro b~ ~x~cvt~d in dupiicst~ and oripinal ~il~d wiTh CIKIc CircuN Cour~, and duplieats wHh Tax Ass~swr.I i
~ Y~169 ~2694 ~
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