HomeMy WebLinkAbout0699 ~ 169'?~1 ;
Deciaration ot Domlcile and Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR, . ~
Sl. IUCIE COUNTY, FlORiOA:
This is my declarotion of Oomicile and Citizenahip in the State of Fiwida that I am filin~ this day in aooordanos and '
in oonformity with Chapter 222, Settion 222.17, Florida Statutes. ~
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I was formerly a legal ~esident of I'• I' N. Y. ~
. • (~;ty) (State) f
~ ' ~
,
1894 Lakeland Aveaue, Ronkonkoma 4
and 1 resided at . However I have chan~ed my domidle ~
(Street and Number) - ~
to and am and have been a bona fide resident of the State of Florida sinoe 19th day of
August _ , 19 68 , and ~ reside ar 6U8-A No. 6th Street ~
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaraticsn of cifizenship, actual legal residenca and domicile in the State of Horida.
(Insert here any pertinent facts, such as sale of property or busineu, or relinquishment of employment
at former domicile, removal of family to new domicile, purthase of horr~e, ett.)
; ~nteriag child in public school
Cheryl-Ann Lopes
~~~~o ,:~1U RECORDEO
. ST, 4,UC1~ C~UNTY, F~,A, '
~~C~~A ~~#~I~JFp
169~~
_ '68 ~~iq z J ~P~1 : 2 I
; _ .
~ :.1r:c~~%~ F'O:TR,•.~
~~~RK C3RCUIT COl1RT
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1 F~JRTHER GERTIFY that I will aomply with all other requirements of a legal'resident of this State.
~ I FURTHER CERTIFY that I have no intention to retum to my former domicjle, and 1 intend to remai~ in FOR7
-
PIERCE,`SA~INTf~lUC1E COUNTY, FLORIDA, permanently. • .
.,,;t~:s:t:rr:j;,_ ' .
~ ~ r. j~ t~Q~~
: ~ (Name) Barbara Lopes
y ~ • •
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, ~ . _ _ - L ~ - (~lddress) ~
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Sworn to and subsuibed before me this 21st day of Augus t ~ ~q 68
. j
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ROGER POITRAS ~
CLERK CIRCUR COU Notary Public
gy ~ D.C. My Commiuion expires
L~ ~
(To b~ ucecut~d in duplicat~ and ori~insl filed witi~ qerlc Cirwit Cour~, and dupli~at~ with Tax Ass~s~ora ~
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