HomeMy WebLinkAbout0621 ~
Declaration ot Dornicile and Cttisenship
ls3~ss
TO THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FIORIDA: ~
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This is my declarotion of Domicile and Citizenship in the State of Florida that I am fili~g this day in accordance and ;
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~n conformity with Chapter 222, Section 222.17, Florida Statutes. j
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I was formerly a legal resident of _ T111HH-___ _ ~Y~ AhOma _
(Ciy) (State)
and 1 resided at _ 4911 __1" ~BBtOn However 1 have changed my domitile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since ____??nd~- day of
t 9~$_, and 1 reside at96
Shaf f er' s 1do tel ~ II. S. ~ 1 Jouth
---January_ -
(Street and Number)
FORT PIERCE, SAlNT WCIE 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 pertinent 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.) k
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~nt~ering Larry in the 2nd grade of school
Yr. Sappington is employed by the " Price Construction ~o. "
and is working on the Florida Gas Systu~ ~
FILEO AND RECOROED~
~ ST, IUCIE COUNTY. FLA:'
RECORD VERlFtEO
i 163'786~
f '68 JAN 24 AM 9' S1 ~
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~ nO:~EP, r QITRAS
~ CLERK CIRCUIT COURT
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~ I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I fURTHER CERTIFY that I have no intention to return to my former domiCile, and I intend to remain in FORT
a
PIERCE, SAI(11.T~•k17~1~~~QUNTY, FLORIDA, permanently.
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S' ~ ~ ' ~(Name)
•:t . ~ ,si~ ~ , _
~ • ; ~ = ldargaret H. Sappington
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•~'rs (Address)
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Swom to and subscribed before me this 24th day of d8riaur3r ~ 19 68
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~ ROGER POITRAS
~ LEAK CIRCUIT COURT Notary Public
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~ gy ~-~-e- D.C. My Commission expires ;
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(To be ~xea~ted in dupliuro snd orisinal ~ilsd witb Cl~rk Grcuit Cou~f, and duplicab with Tax Ass~sior.) ~
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`~4= eaoK 170 P~c~ 619
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