HomeMy WebLinkAbout0394 Deciaratio~ ot Domicile a~d Citizenship ~s~8~-
T(~ THE STATE AND COUNTY TAX ASSESSOR, -
SI. lUClE COUNTY, FIORIDA:
This is my declarotion of Oomicile and Citizenship in the State of Florida that 1 am filing this day in aaordante and
~n conformiy with Chapte~ 222, Section 222.17, Flo~ida Statutes. ;
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I was formerly a legal reside~t of ASHI~D
(Ciy) (State) ~
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and 1 ~esided at ~t' 2 BOZ 118 <i
. Howevar 1 have changed my domiCile
(Street and Number) ~
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to and am and have been a bona fide resident of the State of Florida sinae 25th day ot
lisy ~ 1968 ~ and i reside at 202 $io Y38ta? D~.Dr.
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FI.ORIDA
and this statement is to be taken as my declaration of citizenship, actual legal ~esidence a~d ciomicife in the State of Horids.
(Insert F~ere any pertinent facts, suth as sale of property or busineu, or ~elinquishment of employrnent
at former domicile, removal of family to new domicile, purchase of home, etc.)
; Sntering one child in Publio Sohool
DO~HA SHAR$Ol~ COAVII~L$ (13 yre )
FILEO ANO~ RECORDED?
- ST, I,UCIE COUNTY. FLA. ~
RE CORn R. IFf ~p
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~68 AU6 I 3 PM oe 8~
a~oc~n r-o~; 4
~ CLERK ~1ReUrT COURT `
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1 FURTHER CERTIFY that 1 will oomply with all other requirements of a legal'resident of this State.
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t FURTHER CERTIFY that 1 have no intention to return to my former domicile, and 1 intend to remain ir. FORT ~
PIERCE, SAINT LUCIE COUNYY, FLORIDA, permanently. ~
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~ _ i (Name)
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`\i,`,~~~~~~-~~ •~~J~.,~•~ .
. ; . ~ . _ Bstty d. Con~ille
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68 '
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. `.,~_~(~vor~; fc`~an~suhscribed before me this 13th day of ~u et , 19
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~ ~CI UIT RT Notary Pubtic
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8Y ~.C. My Commission expires
(To b~ uc~wt~d I pliut~ and ori~inal Rl~d witb Cl~ric Cira~it CouA, and duplint~ with Tax Ass~ssor.)
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