HomeMy WebLinkAbout1322 DeCla~atio~ ot Dotnicile and Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR. 17'4108
Sl. LtKiE COUNTY, FIORIDA:
This is my declaration of Domicile and ~tisenship in ths State of florida that 1 am filinq this day in aaoo~danoe and
i~ conformiry with Chapter 22Z, Settio~ 222.17. Flwida Statutes.
1 was formerly a legal ~esident of Teii Citv Indiana
Kity) (Stah)
Box 61-A Rt . - 1
and 1 ~esidad at - . However 1 hava chaiqsd my domkjle
(Straet and Number)
to and am and have been a bona fide resident of the State of Florida since A~gUSt day of
- , 19 68, and I reside at 1119 Colonial Road
(Street. and Number) ~
FORT PI~CE, SAlNT LUCIE COUNTY. RORIDA
a~d this statement is to be taken as my declaration af citizenship, actua! legal residenoe and domicile i~ fhe Stab of Horida.
(Insert here any pertinent facts, such as sale of propery or busineu, or ~elinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, ett.) ~
for homestead purposes
F
t
RlLE~1.AND RE~~~ED'
sT.a~CQRD yUNTY.~p~• _
i'74~.~~
~69 ~p 23 PM ~ Z8
R GER POITRAS
CLERK CIRCUI7 COURT'
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i FURTHER CERTIFY that I wiil oomply w}th all other requlrements of s la~a! resldent of thts Stste.
1 FURTHER CERTIFY that 1 have no intention to retum to my former domicjle, and 1 intend to remsin in FOR7'
PIERCE, SAINT UJCIE COUNTY, FLORIDA, permanently.
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_+`n-..^ _ (Name) Ilene S. yrne
V y ~ -
j . ~ '
. , : t . . ~ .
~ . ~ . ~ , s ~ (AddfeSi) ~
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3~worn ro and subsu~bed bsfor~ me rh~: 23 day of .Ianuar~? 19 69 . I
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ROOER rOfiRAi
~i~Rl( COURT Notary Public
BY ~ O.C. My ~ommissian ~xpires ~
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a. r. .oo.wl«, M d~piiC.~. aaa .ei~wr t~ wi~ u«k c~~ark c~, .~a ~.r. wi~ Ta~c A.......a
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~a ~OOK~75 ~~~e~ ,
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