HomeMy WebLinkAbout2938 Declaration ot Domicile and Citizenship 165
TO THE STATE AND COUNTY TAX ASSES50R,
Sl. IUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of ___.___~aLbBZSY~@__-- -
(City) (State)
and 1 resided at 8~.~ -I.~e
S____~ti'•_QP'~_ _ Nowever I have changed my domitile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _l~t}1_ day of
_ MBrCh 19.~i$--, and I reside at -1,Q~_Srg~rr~ ~,r
i g e
v,~~,,~,e
~ (Street and Number)
FORY PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of emptoyment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Entering children in sc~ool
Bruce C. Toler in 4th grade
OROE~.
FILEO AE~ pUNTY ;
FLA.
i `-'T• ~UC^j,y~
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io 1 3.5~.
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3 ~LERK
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~ I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
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~ I FURTHER CERTIFY that 1 have no intention to return to my former domi~ile, and 1 intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ 1~iC~i/ GCl
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~ _ (Name) Jack W, Toler
~ ti
~
? (Address)
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~~$worR tp and ~ubxribed before me this 18t}] day of March , 19-68 ~
~J• ` .
~ ROGER YOI~RA~ -
~ _ ~ CLEkK CIRCdR"COURT Notary Public
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By D.C. My Commission expires
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~ (To be executed in duplicats snd original ~itsd with Clerlc Grcuit Courf, and duplicate with Tax Assessor.)
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