HomeMy WebLinkAbout2999 16~93~5 .
Oeclaration ot Domiclle and Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Si, lUC1E Ct~UNTY, FIORIDA:
This is my declarotion of Domicile end Citizenship in the State of Florida that 1 am filing this day in aoowdance and
in conformity with Chapter 222, Section 222.17, Florids Stattites.
I was fo~me~ly a legal resident of - I~~ -
(City) (Stata)
and I ~esided at 47 $11~tb~th ~ Oirol• However I have cha~?gcd my domivle
(Street and Number)
.H -
to and artf's~-fiave been a bona=fide ~esident of the State of Florida since - -Tth day of
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Dooeab~r ~ 6? 8tarr Et.--J~nssa Beaoh
_ , 19 and I reside at
- • ' (Street and Number)
FORT PIqtCE, SAINT LUCIE COUNTY, RORiDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horicia.
(Insert here any pertinent facis, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile,'purchase of home, etc.)
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SRT&BIBG CHII.D Ilf 90HOOL
Dl1T S~ LZlIETT$ BIOHIIAI~ {6yre)
169305
FILEO ANA RECORDED~
• ~ ~ ST. LUCIE COUNTY, FLp;~
~ RECORQ 4~RIFI p
1 . ~,I ~
~ '68 At?~ 5 AM 10 : 58
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~ : ROGFR ~OITRAS
CLERK CIRCUIT COURT
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1 RIRTHER CERTIFY that 1 wifl oomply with all other requirements of a lega) resident of this State.
1 FURTHER CERTIFY that 1 have no intention to return to my former domicjle, and I intend to remain in fORT
~
PIERCE, SAINT LUCIE COUNTY, FLORI~A, permanently. '
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~ , , , ~ J`;, 801fAI~ J . RIOFD[AY
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. Sworn' to en~ ~Ubscribed before me this 5th day of ,u~~t ~ 19 68
• • :
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-L~ •~....~i,~t
RC IT COURT . Notary Public
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gy D.C. My Commiasion expi~es
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(To b~ in duplicat~ snd ori~insl fil~d wi~h Cl~elc CirwN Court, snd dupli~a» wiN~ Tax AsMSror.)
sooK172 ~~2981
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