HomeMy WebLinkAbout1640 Declaratlon ot Domicile a~d Citizenship
1'74336
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Flo~ida that 1 am filing this day in aao~rdanoe a~d
in oonformity with Chapte~ 222, Section 222.17, Florida Statutes.
S
1 was.f~rmerly a legal ~esident of Middlefield Conn.
~ (City) (State)
and 1 resided at _ WeSt Strett However I have changad my domic3le
(St~eet and Numbe~)
to and am and have been a bona fide resident of the State of Florida since 2nd day of
November , 19 68, and 1 reside at 120 Rose-l~?!r1Ave.
(Street snd Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIOA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domitile in ihe State of Florida.
(Insert here any pertinent facts, such as sale of property o~ busineu, or relinquishment of employment
at former domicile, removal of family to new domicite, purchase of home, etc.)
in tering Carlene in ttie 5th g~~~~ ANO RECORDEO
CIE COUNTY. Fl~.
_ ::c~,,;-~r, ~rcR?c~FL~
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1 RIRTHER ~ERTIFY tfiat I will aomply with al) other requirements of a lepal resident of this State.
I FURTHER CERTIFY that I have no intention to retum to my former domiGle, and I intend .to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~a.~ .~~!'~-o
; ; . i~'~r,, / ` ~a~,
~ ~ ~ ~ Carl Hicks '
` - . ~ _
- ~ . ~ ' (Address)
i %1 • • . . • ;
. ' January 69
:.S'~Wbti~ ttf~and suburibed before me this 30 day of , 19 -
~ ROGER POITRAS
CIRCUIT OURT Notary Public
~ ~
By D.C. My Commission expires f
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(To b~ ~x~a~hd in duplieat~ snd ori~inal fil~d with Cl~ek Ctra~it Coue~, and duplieata wi~h Tax A~s~er.l E
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