HomeMy WebLinkAbout0827 Deciaratlon ot Domicile and Citisenship 163911 •
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TO THE STATE AND COUNTY TAX ASSESSOR, ;
51. lUC1E COUNTY, FLORIDA: °
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This is my declaration of Domicile and Citizenship in the State of Flo~ida that 1 am filing this day in accordance and ~
in confo~mity with Chapter 222. Section 222.17, Fbrida Statutes. i
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Pask Ra ida Minn i
I was formerly a legal resident of - j
(City) (State) ~
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Park Rapids Golf Club ~
and I resided at However I have changed my domiCile !
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since lst day of
Deceober 68 ?04 Howie Dr.
_ , 19 and I reside at
(Street and Number)
fORT PIERCE, SAIN? LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile i~ the State of Horida.
(Insert here any peninent 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.)
F I LI NG FOR HOINES'TB~AD PURPOS~BS
FILED AND RECOROED
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V~Or~D VuF:TF FDLA~
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'68 JAN 29 PM 3: I ~
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CLERK CIRCUtT COURT
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I FURTHER CERTIFY that 1 will comply with all other requirements of a lega! resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domiqle, and I intend to remain in FORT ~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ;
, (Name)
, ~ JACK /WDBRSON
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• ' ° ~ ~ (Address)
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~ ' ' f • ~ • ' 29th January 68
'=5vvq~f~~rpi
`r~3ubxribed before me this day of , 19 .
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CtR COURT Notary Public
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By D.C. My Commission expires
(To b~ ~xeeut~d in dupliut~ snd oripinal ~ilsd with Cl~rk Cirwit Cour1, and duplieat~ witle Tax Aa~ssor.) ~
~~170 P~ 824
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