HomeMy WebLinkAbout1096 ~
~
Declaration ot Domicile and Citizenship 164084
TO THE STATE AND ~OUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FLORIDA:
This is my detlaration of Oomicile and Citize~ship in the State of Florida that I am filing this day in actordance and
~n confo~.i~ity with Chapte~ 222, Section 222.17, F.lorida Statutes. ~
1 was formerly a legal resident of A~lent0~1 _ PBiI'1.
(City) (State)
and I resided at __?41 802'th Tth etreAt _~Wever I have changed my domiti~e !
(Street a~d Number) i
to and am and have been a bona fide resident of the State of Florida since 1_8t _ day of
_ February_ , t968 ~ and 1 reside ar 8t 2 Bo= II. S. ~ 1 8orth
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, 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 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.) k
r
i
8ntering ohild in echool FILEO AND RECORDEO'
ST. LUCIE COUNTY, FLA.
Eetablishing reeldenae RE~CORD VER~F~ED
164084
'68 ~E6 s AM I0: Se
r' ..~C7tiL.w"" 3
~O.,~R f°O~TR.;S
CLERK CIRCUfT COURT
~
I
1
_ ~
. ~
;
~
I FURTHER ~ERTIFY that I will com I witfi all other ~ uirements of a I ;
p y eq egal resident of this State.
! I FURTHER CERTIFY that I have no intention to return to my former domiule, and I intend to remain in FORT .
PIERCE, SA~(~4~;J~j~(~ COIJNTY, FLORIDA, permanently.
~~,fl~`~~ y -
=~'.,'j.':,:. ~~•.C~:,;!i . r
G~'.
~ • ~ ~ ) {
~ ~ _
: . ~ M11111am J e $alado '
' • . ~ • ~ }
4
i ^ ^ ~ ~ (Address) ~
_ ~ ,
Swom to and subscribed before me this _ 5th day of Feb. , ~q (8 _ s
~
ROCER POITRAS ~
C K CIRCUIT COURT Notary Public ;
BY °'`''G'L D.C. My ~ommission expires
(To b~ ~xecut~d in duplicaM and oripinal ~iled with qarlc Grcuit Cou~f, and dvpliuh with Tax Ass~stor.)
a~K17U PACE1093
~ 1~ . - _ _ - - ,
~ ~ r E ; " -
~ ~ ~ . _ s-'~,~' ~ °~z«
. ~ S~r
, _ . " :l;~p`_> .