HomeMy WebLinkAbout0772 Oeclaration ot Domtcil~ a~d Citiz~nshlp
- 1'73'~4
TO THE STATE AND COUNTY TAX ASSESSOR.
Sl. IIICIE COUNTY, FLORIDA:
This is my declsration of Domicile and ~tizenship in ths State of Horida that 1 am filinq this day in aooonlano~ and
in aonformify with Chapter 222. Settion 222.17, florida Starirtes.
I was formsrly a 1e9a1 rosidsnt of Orbu r n H gt s_ Ir[± ch ~
(City) (Stah) ~
and 1 rosidsd at 860 So. Hampton . How.~,er i have chan~sd n~y domivl~
(Street and Number)
to and am snd have bsen a bons fide resident of the Staro of Florida sinoe ii day o~f
~u~e , 19 68 a~d 1 roside at i~07 Vnrir and Number) -
I~ORT H~, SAlNT LNCfE COUNTY, RORIDA
and this statemsnt is to be taken as my deda~ation of citizenship, actual legai residenoe and domicile in the State of Florida.
qnse~t hem any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domiale, removal of family b new domiale, purchsse of tarne, etc.) ~
~~?~o AN0 R~c ao~at . ~ .
T. ~uc~E covN~~
S RE
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'69 dAN t 0 AM
i~r,~~ TitAS ~
' R COURT~
' CLERK C1RCU1?
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~ i R/RTt~R GE~tTIFY that 1 will oomply witfi all otF~ requireir~enb of a lepal resident of this Shts.
I FURTHER CERTIFY that 1 have no intention to retum ro my former domitile, and 1 intend to remain in FORT
PIERCE, SAINT lUC1E COUNTY, FLORIDA, permanently. ~i~ J/~ ~
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',,..;:ti , • .~r! - (Name)
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- • , f ? ; :s ~ - ~ 1307 York Ave. s
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5ii~o~n~b and wbscribsd before n~ t~+atb day of -~~,••,s . 19~...
ROO~ ~011RAf
C~CIMT COtlRT Not~ry Publk
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By D.C. My C.onx»ission ~xpi~
R~ 1» «a~l~i iw ~licr~ a~i «i~i~al Al.r wi~b G«k C4wM C~wR, aw~ ~lie.~. wid~ T~oc A.~.a
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