HomeMy WebLinkAbout0911 _ . :~sss~s
aaluatlon o~ Domicil~ and Cit~MShip
TO THE STATE ANO COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY. FLORIDA:
Th1s is my detluation o#_Domicile and C1tisMShip in th~ Stat~ of Fiorida tMt 1 sm fili~+q thit day in aooorda~a ~nd
in co~fo?mity with ChaptK 2Z2. ~ Ssttion ~22.17, Florids Statu»s. .
I wss formerly a le~al reiident of ~nnessviile Indisna
(CttY) ~ (Stah)
and ~~~d.d st 1118 Fayett Street ~~~~~,,,y ~~N
- ~ ar~d Numbe~)
ro and am a~d hsve besn a bons fid~ msident of ~he Ststs of Fiorida since JUly 2S _~y ~
Shaffner'a Motel - So. U. S. #~1
, 19 68 , and 1 reside at ~
(Strest and Numbs~}
'ORT SAMrT ItIC~ COUNTY, KiOR~A -
and ifiis staternent is to be taken as my dedsration of citirenship, aduai legal residenos and domkil~ in ths Sta» of Hotids.
pnsart hem amr pe~tinent fscn, such as sale ot prc3perty or bu:iness, or rolinqui~ms~t of employm~nt
at forms? domicile, ramoval of family to new domicile, purcha~ of homs, etc.)
Placing children in school
Bernadine Gale Cummins ~
Bernard Gale Cunmias, II
FIlEO ANO RECORDED
8T•R~~C~~ COUNTY. FLA, ~
~~~T~~~ -
~
' - '68 A~r 2 7 PN 12 : 3 3
~
~ RO~ER FOITR,~S '
C~ERK OIRCUIT COURT
1 RJRTHER GfRTIFY that 1 wiil aornpiy witfi ali oth~r nquin~r~snts of a le~al r~ident of fhu Stat~.
1 FURTHER CERTIFY that 1 have no intention to retum to my former domic,ile, and i intend to remain in FORT
PIERCE, SAINT UlCIE COUNTY, FLORIDA, permanently.
..y
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~ _ - 1T~e) HSrj1 B~ ~:UID1allls
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" • r. . (A,ddress) .
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. r,, 19
~,Swo~i~~io and wb:cribed befom me thi: 27th ~ay ~ August 68,
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~ ROOf~ tORRAs
Q~RK ClRCilR COURT Notary Publk
gy .C. My Commission ~xpiros
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- (Ti 1» ~~al~ i~ d~ikal~ awd ai~iw~i fiMd wMM Cl~k Cka~it Cew~~4 apd d~CaN w~ Tax A~~,1
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~ ~~1?3 ~?~E 903
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