HomeMy WebLinkAbout2649 Declaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, c
Sl. LUCIE COUNTY, FLORIDA: ~V `1SV
This is my declaration of Domicile and ~itizenship in the State of Florida that I am filing this day in atcordance and
~n conformity with Chapter 222, Section 222.17, Flo~i~a Statutes_
Diana •est Qirginia ;
I was formerly a legal resident of - !
(City) (State) ~
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Diana west Virginia '
and I ~esided at Howeve~ I have changed my domici~e
(Street and Numbe~)
s
ro and am and have been a bona fide resident of the State of Florida since _-___-_1~t1L--- day of
_YB,~__ - , 19
68, and I reside at 2~4 ~TO. 17th $tl"@Bt
(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 forme~ domicile, removal of family to new domicile, purchase of home, etc.)
To enter child in actiool i
Dau hter - Deborah Jean 3tout F~LEp AN~ RECORDED~__
g gT. LUC~E COUNTY. FLA•
c<r cQ~;~ v~~s'7186 .
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'68 MAY 1 ~ PM
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" ~tOGER i OIYR~S j
; CI.ERK CIRCUIT COURT ~
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1 FURTHER CERTIFY thst I will comply with all ofher requirements of a legal resident of this State.
~ I FURTHER CERTIFY that I have no intention to return to my forme~ domiule, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ ~J!~'Q~~ ,
~ ame) Lola Imogene wari ~
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~ Sworn b~nd subscribed before me this day of _-~L~[ , 19 68 t
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. ~T" ~ Nofery Public
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~ ey ~ r` ~ D.C. My Commission expires
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~ (To 6~ ~~arfid In dupiiut~ and eri9inal Al~d wilh CIKIc G~ Coue~, aed duptiuN wi~h Ta~e A~.)
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~ b00K1~1 PACE~V~
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