HomeMy WebLinkAbout0866 Declaration ot Domicile and Citizenship 1639~3~
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance a~d
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of -~~H p~T _ N. Y. _
~~;ty~ (State)
and 1 resided at _ 111 $CUttel P1. ~V1eV~ ~ have changed my domitile
(Street and Numbe~).
to and am and have been a bona fide reside~t of the State of Florida since lst day of
Noveober 68 4702 Ave. Q
_ _ , 19 and I reside at
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA ~
and this statement is to be taken as my declaration of citizenship, adual legal ~esidence and domicile in the State of Flo~ida.
(Inse~t here any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
FILING FOR HOI~STBAD PURP06BS
~
~ FIlEO AND RECORQED #
ST. ~L'CIE COUNTY. FLA. 1
~E,GOR~ VERIFIFD
1s3s3y
'68 ~l4~ 30 ~1 I~: 32
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~ CL~RK ClRCUIT COURT ?
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~ I FURTHER CERTIFY that I wil) comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domiu~e, and I intend to remain in FORT ~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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~ / ~ ~~~i1 L ,
(Name)
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~ ~,,~~u,,•~:rrj.r~,., . CHARTBS D. WALY$R '
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y f~ . : _ . (Address)
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~ Sworh t~3.~+~ subscribed before me this 30th day of J~ uary ~ q 68 ,
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UIT COURT Notary Public
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gy D.C. My Commission expires ,
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~ ~x~cuhd in du licat~ and ori inal fil~d with ClKlc Grcuit Court, and du icat~ with Tax Ass~s~or.) `
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~ 600K 1~O PAGE O~
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