HomeMy WebLinkAbout1493 Declaratio~ ot Domicile a~d Citizenship j643s3
TO THE STATE AND COUNTY TAX ASSESSOR,
51. IUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day 6^ accordante and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of _ VIEI~INA W. VA.
(City) - (State)
815 25th St.
and I resided at _ _ _ _ _ _ _ _ - _ . However 1 have changed my domitile
(Street and Number)
!o and am and have been a bona fide resident of the State of Florida since 12th _ day of
February 68 Dixie Mobile Homes•S. U. S. ~1
19~---, and I reside at - - -
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be take~ 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.)
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FdVTBRING TMUO CHI~DRBi~ IN PUBLIC SQi00IS
DAVID M. SHOCKBY (19 yrs) ~
fiLEO arvo RECOROED ~Q 1~ v
BILLIB J. BURD (9 yrs) S~. LI~CI~ r~ ~f~, p
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z I FURTHER CERTIFY that I will compty with all other requiremenis of a legal resident of this State.
1 FURTHER CERTIFY that I have no intenfion to return to my former domic,ile, and I intend to remain i~ FORT
~ PlERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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8 (Name)
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} . Brnestine J. Burd
a -
` ~ (Address)
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~ • -1 • ' ~ ~ , - 14th Pebruary 68
: Swb~n; tcr.and =vbscribect before me this day of , 19 .
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+ t,l~, C I COURT Notary Public
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~ By D.C. My Commission expires
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(To be executed in duplicate and original filed with Clerk Grcuit Court, snd duplipts with Tax Assessor.)
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