HomeMy WebLinkAbout0980 ~
Declaration ot Domicile a~d Citizenship 164011 ~
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TO THE STATE AND GOUNTY TAX ASSESSOR,
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Sl. LUCIE ~OUNTY, FLORIDA:
This is my declaration of Domicite and Citizenship i~ the State of Florida that 1 am filing this day in accordance and
in conformity with Chapte~ 222, Section 222.17, Florida Statutes.
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I was formerly a legal ~esident of -
~C~ty~ (State)
and I resided at ?94~ PL1188Y1 HY131. Bt. 4~ ~Wever 1 havechanged my domiti~e ~
(Street and Numbe~)
to and am and have been a bo~a fide resident of the State of Florida since __-__l?th day of
I
~ 3eptemb~r 6T 205 S• Arbor ~
_ _ , 19 and I reside at
(Street and Number)
fORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, adual legal residence and domicile in the State of Florida.
(Inse~t 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.) ~
~'ILIH(~ FOR HOMEST&AD PUBPOS$3
FILEO A~~O RECORDED
ST. l.UCIE COUhTY. FLA. ,
~E.CORD V~RtFIFp
164011 '
'68 FEB I AM l~ : 21
CLERK,CIRCUIT COURT
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~ I RJRTHER CERTIFY that I wil) comply with all other requirements of a le~al resident of this State. ~
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I FURTHER CERTIFY that I have no intention to return to my former domiSile, and I intend to remain in FORT {
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PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ;
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r~ : 'j - : • = lat ~'ebruary 1968 !
~ ~ S~v_orq,~t~ ail~cR~tlburibed before me this day of , ,
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~ CLERK IRC I COURT Notary Public ~
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~ gy D.C. My Commission expires
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(To b~ ~xscut~d ' duplicat~ and oripinal filed witi~ q~?ic Grcuit Court, and dupliuts wifh Tax Ats~ssor.) .
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amK 170 977 - _
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