HomeMy WebLinkAbout0746 Deciaration ot Don~icile and Ctttzenship
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TO THE STATE AND COUNTY TAX ASSESSOR,
~
ST. LUCIE COUNTY, FIORIDA:
This i: my decla~etion of Oomiciis and Citizenship in the State of F{orida that 1 am fiti~q this day in aoo~rdanos- and
~n aonfwmiy with Chapter 222, Settion 222.17, Florida Statutes.
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I was formeriy a leqal ~esident of BlOOmYield Ne~r ~ereey
(City) ~at~) -
and I ~esided at 189 Blsdwin PlBOe However 1 have d~sn9ed my domiciie -
(Street and Number)
to and am and have been a bons fids resident of the State of Florida sinoe 15th dsy of -
Auguet ~ ~q 68 a~ at Rt 1 Bo~c 315 II 8 l~0 1~iorth
(Street and Number) `
FORT PIERGE, SAINT WCIE COUNTY, RORIDA -
and this statement is to be taken as my declaration of citizenship, actual legal ~esidence a~d domic~te in the State of Florida.
pnsert here any pe~tinent facts, such as sale of property or buaineu, or mlinquishment of emplaymer~t
at forme~ domicile, removal of family to new domicile, purchase of home, erc.)
~ Setabliehing reeidence and placing ohild in sohool
FILEO AND RECORDEO , .
ST.RECORO VER(F E~`A• ~
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~sa ~t~c 22 PM ~ ~ i 8
l i~UGEit FOi7RMS .
f CLERK CIRCUIT COURT -
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I RIRTHER CERTIFY that I wili oomply with all other roquirements of a leyal'resident af this State.
~ I FURTHER CERTIFY that 1 have~no intention to retum to my former domicjle, and I intend to ~emain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. -
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~ % . V-. ( ldre Georga
~ ~,•o•: _ Joan 8ayaon
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j!~'y ~ ~ 4 . (Address)
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=";SW~Mn'to,aixl~subsuibed before me this 22nd day of ~gt , 19_.5.~.
: "
ROGER POITRAS '
GIRCUR COURT Notary Publk
t
gy D.C. My Commission expires '
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(To b~ ~xeartod in dupticat~ and ori~nal fil~d witb qKlc C'ua~it Co~~, and dupticat~ with Tax At~ss~orJ
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