HomeMy WebLinkAbout0904 Declaration of Don~iciie aed Citizenship ~
TO THE STATE AND COUNTY TAX ASSESSOR,
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ST. IUCiE COUNTY, FLORIDA:
1'73~827'
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in aooordanos and
in oo~formity with Chapter 222, Section 222.17, Florida Statutes.
North Brook Illinoie R
1 was formerly a lagal ~esident of
(Ciy) (State)
1227 Waltere Ave.
and 1 resided st . However 1 have changed my domidle
(Street and Number)
b end am and have been a bona fide resident of the State of Florida sinca _~_J~1~ 1~ day of
, 19 68 and I reside at 4804 Evergreen Avenue
(Street and Number)
FORT M~CE, SAINT LUCIE COUNTY, RORIOA
and this statement is to be taken as my declaratio~ of citizenship, actual legal residenoe and domicile in the State of Florida.
pnse?t here any pertinent facts, such as sale of property or business, or relinquishment of employment •
at former domicile, ~emoval of family to new~ domicile, pu1chase of home, etc.)
homeatead purposes
FIIED ANO RECOROEO~
ST. LUCIE COUN'~Y. ~LA:
RECORD VFRIFIEO
1'7382'7
. '69 JAN I q AM 1 I: t
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RO POITRAS
CLER CIRCUIT COURT:
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I RIRTHER CERTIFY that 1 will comply with all other requirements of a lepal resident of this State.
1 FURTHER CERTIFY that 1 have no intention to return to my former domitile, and I intend to remain in FORT -
PIERCE,,.SAINT LUCIE COUNTY, FLORIDA, permanently. ~
~ " V T -8~ ~~s d~-~s
• ~ _ (Name) Ferd inand oe er
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(Address) ~
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Sworn ro snd subscribed before me this 14 day of Januery, 1969 , 19 .
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p~As
CLtRK C~CWT COtlRT Notary Public
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- By .~_s,~~'2 O.C. My Commission ~xpir~s
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