HomeMy WebLinkAbout0320 Declaration ot Dornlclle and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, 163~~
51. LlJCIE COUNTY, FLORIDA:
This is my decfaration of Domicile and Cilitensh;p in the State of Florida that I am filing this day in aaordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of ___._gOeC1L18k0 _ ~d188i881pp1
(Ciy> (State)
and I resided at _ 305 ~ergre@n Dtioe Howeve~ 1 hava changtd rr~y domiGle -
(Street and Numberj '
to and am and have been a bona fide res+dent of the State of Florida since _ l~th day of
+L~~]~'3t- 1968 , and I ~eside at 1115 Su1t11~Bri AV9
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIOA
and this statement is to be taken as my declaration of citizenship, adual legal residence and domicile in the State of Horida.
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{Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment i
at former domicile, removal of family to new domicile, purchase of home, etc.)
Establishing residence and entering child in echool
FILEO AND RECORDED:,_
ST.RE CQRD VERlF E~`A. : 91
4s3s
'66 JAN 22 ~ 8 ' y ~
:.c?~;=~r. =-J!~TRr.s
CLERK CIRCUtT COUR7 ;
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I FUR7HER CERTlFY that 1 will camply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no inteniion to retum to my former domicjle, and ! intend to remain in FORT
' j
i PIERCE; :~lYfNfi:J~1CIE COUNTY, FIORIDA, permanently.
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! ,J. .,;J~i•• •~~~~C~•, ~ l w
f G~ : C~f~/
. ~ i'' ~ -
' _ ~ : (Name)
' ~ . ` V _t. ' - Yrs F. C. Black ( Betty Jane )
I~•/'- ' l{
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, . ^ :.ti V (Address)
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Sworn to and subsuibed before me this 22na day of J~a~Y 19 68
.
ROGER POITRAS
IERK CIRCUIT COURT Notary Public
~Y D.C. My Commission expires
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(To b~ ~x~c~rted in duplicats and oripinsl filed with Ct~ic Circuit Court, and duplicsts with Tax Ass~ssor.) ;
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