HomeMy WebLinkAbout1684 Declaration ot Domicile and Citlzenship
~ 1'~4361
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA:
This is my detlaration of ~omicile and Citi:enship in the State of Florida that I am filin~ this day i~ acoo~danos and
in conformity with Chapter 222, Section 222.17, Florida Ststutes.
1 was forme~ly a legal resident of 1"~~chen _ M1est YirAinia
(Cty) (State)
and 1 resided at _ 32 Tetlth St r@et , However I have chanyed my domic3le
(Street and Numbe~)
to and am and have been a bona fide resident of the State of Florida since 8th day of
August 68 1?? Liberty way
_ , 19 , and 1 reside at
(Street snd Number)
FORT PIERCE, SAINT LUCIE COUNTY, FtORIDA
and this statement is to be taken as my declaration of citizenship, actual legat residenoe and domiale in the State of Horida.
pnsert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, remova) of family to new domicile, purthase of home, ett.)
for homestead purposes
FILED AND RECORD~D=
ST. LUCIE COUNTY. FL~.
RECORp VEP.IFfED
1'74361 E
'69 JAN 3 I PN 12 : S3
ROCER r0~
CIERK CIRCUlT COURT
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I FURTHER CERTIFY that { will aomply with all other rsquirements of a lepal resident of this State.
1 FURTHER CERTIFY that I have no intention to retum to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. {
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'.'-:i~ti . (Nnme) J, yV, Board
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~ 31st January 19 69
;.$wprr~ to and subscribed before me this day of , -
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, • :
ROGER POITRAS
CLE,RK CI UIT COURT Notary Public
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8y D.C. My Commiuion expires
(To b~ ~x~arhd in dupllut~ and ori~nal Alsd wilh C{Klc CirarM Cour1, and dupllcat~ with Tax Assa~or.)
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