HomeMy WebLinkAbout0012 ~ Declaratio~ ot Domicile and Citizenship
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TO THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filin~ this day in eooordance and
~n conformity with Chapter 222, Section 222.17, Ftorida Statutes.
! was formerly a 1e9a1 resident of CLossville _ Tennesse~
(City) (Stats)
and 1 resided at ~ utC S BOx $26 . However 1 have chanyed my domicile
(Street and Number)
to and am and have been a bona fide ~esident of the State of Florida since t~th day of
- -----~-811~18rT- , 19_II.B, end 1 roside at 7l)7 Emil Av~nLe
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA ~
and this statement is to be taken as my dectaration of citizenship, actual legal reside+~ce and domicile in !he Stste of Ho~ids.
(Insert here any pertinent facts, such as aale of property or business, or relinquiahment of employment
at former domicile, remova! of family to new domicile, purchase of home, etc.)
~ntering children in schoo 1
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1 FURTHER CERTIFY that I wil) axnply with al) other requirements of a lepal resident of thia State.
,
1 FURTHER CERTIFY that I have no intention to retum to my former domi~ile, and i intend to remai~ in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
(N e) Mrs . Jim Bvans
( Louise) lricv~~u~
70? Emi1 Avenue, Pt. Pierce, Pla.
(Address) ;
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Swor~~fo'~pnd subscribed before me this - 1~*h day of - _Tanuaty ~q~_, ~
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: ~ Roc~~e -.~po!I~?s - ' i
' ~LERK~C~~UI~ COU Notary Public '
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gY~ D.C. My Commission expires i
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(To b~ ~z~cut~d in duplicah snd oripinal fil~d witb Ct~rlc Cirarh CouM, and duplicat~ with Tax Ass~ssor.j ,
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800K 1~ P~CE ~,z
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