HomeMy WebLinkAbout1067 Declaration ot Domicile and Citizenship 164~3
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FIORIDA:
This is my declarotion of Oomicile and Citizenship in the State of Florida that I am filing this day in acoordante and
~n conformiry with Chapter 222, Section 222.17, Flo~ida Statutes.
I was formerly a legal reside~t of -Yar2j.~#~j'iii_ _ Oh1o _
(City) (Stab)
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and 1 resided at lOO Q1~8]1 However 1 have changed my domiG+~e ~
(Street and Number)
to and am and have bee~ a bona fide resident of the State of Florida since -____~f$__ - day of
__jg~yg~~ 19 5~ and I reside at 101 Horth lTth 8tra~t
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual lega) residence and domicile in the State of Flo~ida.
(Insert here any pertine~t fads, such as sale of property or business, or relinquishment of employment
at farmer domicile, removal of family to new domicile, purchase of home, etc.)
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~tering Tinothy Sd~ard in 5th Grsd• ~
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and Edwin Zss in the 8th grad• oi sohool~ '
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€ I FURTHER CERTIFY That I will comply with all other requirements of a lega) resident of this State. ~
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~ I fURTHER CERTIFY that I have no intention to retum to my former domicjle, and I intend to remain in FORT ~
$ PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently. ~
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j ! (Nam~e. 8Z~1 lBr
; P. 0. Boz
= 162~T.aort pieroeT o~aa
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~ Sworn to and subscribed before me this -Tt$ day of 3~~~ F~brus+~ , 19~$_.
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ROGER POITRAS., ~
' CLERK CtRCU1T COURT Notary Public ~
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; ~Y " ' D.C. My Commission expires
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~ (To- b~ axe4ubd in du~licah oripinal Rled with Gerk Grwit Court, and dupliub wHh Tax Ass~s~or.) ~
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