HomeMy WebLinkAbout0074 Declaration ot Domicile and Citisenship
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TO THE STATE AND COUNTY TAX ASSESSOR, 165443
Si. LUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citiienship in the State of Fiorida that 1 am filing this day in accordance and
in conformity with Chapter 222, Settion 222.17, Florida Statutes.
I was formerly a legal resident of - Ori~O ^ _ Ir1ai~le _
(Ciy) (State)
and 1 resided at 104 N Main Street ~~„~ever 1 have changed my domitile
(St~eet and Number)
to and am and have been a bona fide resident of the State of Florida since 30th day of
- ---_-------_----_-JU~e , 19
67, and 1 reside at ~Ol Nnrth ?~rrl ~t~a~t
(Street a~d Number)
FORT PIERCE, SAINT LUt1E COUNTY, FLORIDA -
and this statement is to be taken as my declaraiion of citizenship, actual legal residence and domicile in th~ 5late of Florida. }
(Inse~t here any pertinent facts, such as sale of property or busi~ess, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
fistablishing residence and applying for homestead
-165443
FILEO ANO RECOROED'
ST. LUCIE COUNTY, FLA.
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! '68 t~IAR 22 AM 9: 3 g
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, t ;tp~~F r VI Rt.S
~ CLERK CIRCUIT COURT
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1 FURTHER CERTIFY that I wil) oomply with all other requirements of a leyal resider.t of this State. ~
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I FURTHER CERTIFY that I have no intention to return to my former domicjle, and I inte~d to remain in FORT ~
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PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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~'~t~sit~~i:::;.. ,
1 C ,~j'., . (Name)
- ~~;'~~'~,t: ~ Isabel Malo ( Mra Roland )
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~ _ ~ ~ ~ ~ r~ ~ ,Q (Address)
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~ 4 ~ ~ ' 22nd March ~q68 ~ ~
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~uburibed before me this day of , • ~
'~if~, C I E I
. :...:...,~a~~•.
ROGER POITRAS
CLERK CIRCUIT COURT Notary Public ~
/1~ ;
ey -~-~-L 4 D.C. My ~ommission expires y
(To b~ ~x~cut~d in duplicah and oripinal filed with Cl~lc Uraiit Cour~, and duplicab with Tsx /1ss~sor.) ;
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°~oK 171 p~cE ,74 i
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