HomeMy WebLinkAbout1465 E
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Mcla~atlo~ ot Domicile a~d Citis~nship !
1'7421'7 ~
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TO THE STATE AND COUNTY TAX ASSESSOR, f
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51. IUCIE COUNTY, FLORIDA:
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This is my deciaration of Oomicile and Citizenship in the State of florida that I am filin~ this day in aooo~danoe and ~
in oonformity with Ghapter 222. Section 222.17. Flo?ida Statutes. ~
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Salem IIlew Terse ~
1 was formerly a lagal residsnt of X
fC~tY) (Staro)
and 1 rosided at 145 New UniOn StiCCt . However ~ havecharpsd my domicile ~
(Street and Number) ~
ro and am and have been a bona fide ~esident of the State of florida since Sth day of
September ,~9 i~ 6~Id I reside at 608 Cocoanut Ave., River Park ~
(Street and Numbsr) '
FORT NQCE, SAINT LUCIE COUNTY, ROR~A
and this statement is to be taken as my declarotion of citizenship, actual Iegal res'~denoe and domicile in the Stefs of Fbrida. E
qnsert here any pertinent facts, such as sale of property or busineu, or ~elinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
~ FILED AND RECpRO~si ~
ST. WCIE COUNTY. RI,A:
R~CORD VERIFIED
1'7421'~
'69 JAN 28 AN 9: 3
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ROGEr~ 0lT~tAS
' CLERK CIRCUIT COURTs
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I FURTHER GgttIFY that i will aompiy witfi all otheir requiremenn of a le~al resident of thls State. =
1 FURTHER CERTIFY that I have no intention to ret mer domicjle, a intend to remain in FORT
PIEltCE, SAINT lUC1E COUNTY, FLORIDA, permanently. ~
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- . - . (Name)
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~ ` 6Q8 Cocoanut Ave., River Park
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` (A~ddress)
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S~w~orn tornd wbscribsd before me th~s 28th ~y ~ Tanuary , 19 69 . !
ROOER ~OfTRAt
CIRCYIT COt1~T Not~ry Publk
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8y D.C. Mr Con+miuion ~xpi~
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R~ M~ae~N~ M~MeM~ a~ ~i~al AI~ wNl~ CM~Ic praih C~w~, aw~ ~ witb Ta~c A~~.~ i
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