HomeMy WebLinkAbout0232 De~la~atio~ ot DomiCile and Citisenship 163634
TO THE STATE AND COUNTY TAX ASSESSOR, ~
Sl. LUCIE COUNTY, FIORIDA: _
This is my declaration of Oomicile and Citizenship in the State of Florida that I am filing this day in acmrdance and ~
in conformity with Chapter 222, Section 222.17, Florida ~tatutes. ~
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1 was formerly a legal resident of FlBt 80CY _ 8
(Ciy) (Stab)
25139 Yiddlebelt
and 1 resided at However I have changed my domitile
(Street and Number) ~
to and am and have been a bona fide resident of the State of Florida since ~__~".13th _ _ day of 4
~
_ Januar~____, 1968 , and 1 reside at Orange Ave B=t, Ht 3 Boa 542 B_~
(Street and Number) •
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FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, act~al legal residence and domicile in the State of Florida. ~
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(Inse~t here any pe~tinent 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 reaidence
Placing 4 children in public achool
F~~ED AND RECORDED
ST, LUCIE ~OUNTY '
R~ ~~R~J VERIFIEO~A. ~
163~4 ~
'68 JAN ~ 8 p~y 3
~ 59
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i CIERK~~~ `'OtTr~hs
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~~R~U1T COURT
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I RJRTHER CERTIFY that I will comply with all other requirements of a(egal resident of this State.
I FURTHER CERTIFY ihat 1 have no intention to return to my former domiGle, and I intend to remain in FORT
~ rmanentl .
~ PIERCE,;~AIP~ E,~CIE COUNTY, FLORIDA, pe y '
,~~i,~.. 4 s...,, ~
2~ Y'-~- • Z% .
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~ - ~ , (Name)
e t ty W i imghaa ( 1[r s Thoma s)
_ _ -
~ _ ~ (Address)
~ ,r•, r .i~, 68
^ 18th Janaury
~ Sworn to and subscribed before me this day of , 19 .
~
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~ ROGER POITRAS
~ LERK CIRCUIT COURT Notary Public
~
~ gy ~d`~~' D.C. My Commission expires
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(To b~ ~xecuhd in duplicat~ and original ~iled with CIKIc Circuit Courf, snd duplicat~ wiM~ Tax Ass~ssor.)
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