HomeMy WebLinkAbout2375 Decla~ation ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, 16494~
Sl. IUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citize~ship in the State of Ffo~ida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was forme~ly a legal resident of _RiVer VieW M1Ch~A8I1 _
(Ciy) (State)
and I resided at ______14510 She~laadOah Drive ~,,,~e„~ ~ have changed my domitile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since -_________20th day of
_AuguSt ~ ~9
6? , and I reside at 1051 Trinidad
(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 ihe State of Florida.
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at former dom:_ile, removal of family to new domicile, purchase of home, etc.)
Establishing re~idence
FILEO AND RECOROEDI
ST.~LUC ~E ~ DUNTF EoLA•' (
16494-~
'68 MAR 5 PM 1: I Z~~~,r,~ .
~
I ~cQ.i.r-. i ~?!iP.i,s
' CLERK CIRCUIT COURT
1 FURTHER CERTIFY that 1 will comply with all other requirements of a lega) resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domiCile, and I intend to remain in FORT
PIERCE, Sq~(~Z; J;UCIE COUNTY, FLORIDA, permanently.
_ -C 'j•:~;~ ~
` : c`' • ~ L
` t+~' - • G , ;n~',~'~ Q-~' l../ A'~
; v . ~j - ~Name)
- ~ _ ~ ~ = - Ja queline Scott ( Mrs Harold )
~ ~ :
F, . 1 '
.\r • ~ • '`,t•`` (Address)
'
irrr:.•
.
Sth February 68
Sworn to and subscribed before me this day of , 19 .
~
ROGER POITRAS '
CIRCUIT COURT Notary Public
8y °`~~u'~ D.C. My Commission expires
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(To b~ ~xscvtsd in dupliute and ori~insl filsd witb Clerk Ci~ait Court, and dupliut~ with Tax Ass~ssor.) '
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d00K1 ~O PACE~, )e IJ~J
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