HomeMy WebLinkAbout1040 Oeclaration ot Dort~icile and Citizenship 1?~3912
TO TME STATE AND COUNTY TAX ASSESSOR,
51, IUCIE COUNTY, FIORIDA:
This is my declaratio~ of Domicile and Citizenship in the State of Florida that 1 am filin~ thi: day in aooordancs and
in confo~mity with Chapte~ 222, Section 222.17, Flo~ida Statutes.
1 was fo~merly a legal ~esident of NIRIGHTSVILE PEIJNSYLVAI~I~
~~;ty~ tStats)
and 1 resided at NORTH FRONT STRSEr , Flcwever I have changed my domitile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since 8th day of
JULY 1q
68, and 1 reside at RT• 1 BOX 352~ FT.PIERCE~FLORIDA
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTIf, EtORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at forme~ domicile, removal of family to new domiale, purchase of home; etc.)
HOMESTEAD PURPOSES
~ILEO AND RECOROED
ST. FV~~Rr VuRIF EO~A:
1'739i2
'69 JAN 16 PM h' 23
i~%~
R POITRAS
CL K CIRCUIT COURT
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1 FURTHER ~ERTIFlf that 1 will aomply with al) other requirements of a le~al resident of this Stste.
1 FURTHER CERTIFY that 1 have no intention to return to my former domic,ite, and 1 intend to remain in FORT
PIERCE, SAINT LUGE COUNTY, FIORIDA, permanently.
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. . . , ~ ~ ~/%l~f,~.1~t~~
. . . NOLLI S H . CROWELL (Name)
, \ -
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~ _ ~ RT. 1 BOX 352
" ~ . ~ ' (Address)
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~ Sv+Ietn,lo`' ~?buribed before me this 16th ~y of JArti UARY ~ 19 69 ,
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ROGER POITRAS ~ ~
CLER~C CtRCU1T COURT Notary Public
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ey ,-u't'~ D.C. My Gommiuion expires
(To b~ ~x~aiad iw duplisal~ and ori~iwal fil~d with CINk Grwit Cowt, and dupticat~ with Yax Ast~s~or.~
~i ~5 ,~1037
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