HomeMy WebLinkAbout1042 ~
Declaration ot Dom~
if.11e and Citizenship 164046
TO THE STATE AN~ COUNTY TAX A~SESSOR, j
;
Sl. IUCIE COUNTY, FLORIDA:
This is my dectaration of Domicile and Citizenship i~ the State of Florida that I am filing this day in accordance and
im m~formity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of pOrt~eV1T16 YO. ~
(Ciy) ~ (State) ~
~
• ,
Conra Qeneral Del.
and 1 resided at However I havechanged my domicjle
(Street and Number)
to and am and have been a bona fide ~~sident of the State of Florida since _17th_. _ day of
January 68 Rt 3 Box 490-13
19-_-, and I reside at _
(Street and Number) ~
FORT PIERCE, SAINT LUCIE GOUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(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.)
.
~ntering child in school and eetablishing residence
FILEO AND RECOROEO
FLA.
ST.~EC Rn ~ERIFIED
1s4o46 03 ~
:
'68 FEB 2 PM 3
J~~~.~~"`,~
:tiU;;c_R i'U1TP~.S
~LERK CIRCUI? COUR7
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 domicjle, a~d I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
:;~~;:ti~ ~
`C,.~ - . ~ (Name)
~ ~ . r Leon Bennedy
~ i ..y . , -
_ ~ . -
. .
~ ~ ~ Y~ ~ ~ ' (Address)
: - .
•••t',~~~~`~,`
` • -
Sworn to and subscribed before me this 2nd day of Feb• , 19 68.
ROGER POITRAS ~
CtitCUIT COURT Notary Public 1
1
s
By D.C. My Commission expires ~
t
~
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(To M exscuted in duplicat~ a~d ori~inal filsd witb Cle?k Grcuit Court, and duplicsh with Tax Asssssor.) '
~ a~x~70 ~~E1039
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