HomeMy WebLinkAbout0620 DeClaration ot DomiCile and Citisenship 163'785
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORI~A:
M
This is my declaration of Domiule and Citizenship in the State of Florida that 1 am filing this day in accordance and ~
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in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of ____~~e;Alal1 I~1153~SSiDQ~ _
~C~ty~ (State)
Rt 2 BOx 141 However 1 have chan ed m domitile
and I ~esided at 9 Y
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since 21St day of
anuar 919 $0 25th Street
------J-- ----y-.-- 19_68 and I reside at -
(Sireet and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be take~ as my declaration of citizenship, actual legal residence and domicile in the State of Flo~ida. ~
(Insert here an rtinent facts, such as sale of property or business, or relinquishment of employment ~
Y Pe
at former domicile, removal of family to new domicile, purchase of home, etc.) •
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,
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Bntering Debra in the lst grade
Mr~ Black is with the Price Construction Co. working on the
Florida Gas line ~
F~~E~ ANO RECpRD
~T.
FUCIE COUNTy
coRO v~R ~ F~A.
~FrEo
'68 JAN 2y 1s3~85
~4I~t 9 ; s l ~
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E C ftQ~i: I OIt' ~
; LE~K CIRCUIT COURT ,
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~ I FURTHER CERTIFY that I will comply with afl other requirements of a lega) resident of this State. ~
I FURTHER CERTIFY that I have no intention to return to my former domiGiie, and 1 intend to remain in FORT ~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently_
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~ ' ..:-•Y:~O'ff/• •~L..~ ~V l~
. V ~a~l.~ti~~- fi _ 1
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, ~ 'o' ? Bonnie Bi~ac~e)
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i~'•~•:...;,~.. -
~ ,Swoi'ii to'and subscribed before me this 24th day of Jan~try 19 68
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~ ROGER POITRAS
~ CLERK CIRCUiT COURT Notary Public
~ a~-c-/E-Ge. -
~ 6y D.C. My Commission expires
~To b~ ex~cut~e! in dupliut~ sed ori~inat filsd wrth C~k Grcuit Cou~f, •nd dupliut~ witl~ Tax Ass~s~or.I
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~ a~170 P~~E 618 '
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