HomeMy WebLinkAbout2144 Declaration of Domicile and Citizenship
. 16~ ~'~S
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile a~d Citizenship in the State of Florida that I am filing this day in acco~dance and
in conformity with Chapter 222, Section 222.17, Florida Statutes. '
Iuka 1[isaissippi
1 was formerly a legal resident of -
(City) (State)
Rt 2 Boz 2 6
and 1 resided at However I have changed my domiCile
(Street and Number) ~
~
to and am and have been a bona fide resident of the State of Florida since _~9th_ day of
_Januar~r___, 19____68and I reside at ___Rt_ 3 Bo~c 490 ~
(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 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.)
Entering children in school F~LEO AND
ST, ~V~~E RECOROED'
tr: r,~:-: ~~UNTY, F~a.
'68 FEB Zg 164~~5
~ 10 : 45
r . ~
' 1~ ~
CIERK'--^ r•UrTR~s
CIRCUIT COURT
i
i ~
F
k
f1
! ~
~
~ .
~
~ 1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTlFY that I have no intention to return to my former domiGle, and I intend to remain in FORT
~
PIERCE, SA~N7:(,~IE COUNTY, FLORIDA, pe~manently.
. / ~ ~
~ , j . , ; ~
~ ~ ~ (Name) ~.1
~ - . .
~ ; ; . t ~ Helen Loretta Walters ( Mrs John)
~ ' -
-P '~C• (Address)
~ ~ ~^•r•
~ J ? 29th February 68
Sworn to and subscribed before me this day of , 19 .
~
~
-
~ ROGER POITRAS
~ LERK CIRCUIT OURT ` Notary Public
~ ~ -
By D.C. My Commission expires
~
~
~
~ (To be executed in dupliute and original filed witb CIKk Grcuit Cou~f, and duplicate with Tax Assestor.) ~
~
~ ao~K170 P~~1~ '
. „ - - -
- - - - - - _
= _
-~`z ~e^'s ~s~-"x(~.~y ~ ~ x
~ _