HomeMy WebLinkAbout2119 1'~4636
Declaration ot Domicile and Citizsnship
TO THE STATE AND COUNTY TAX ASSESSOR,
51. IUCIE COUNTY, FIORIDA:
This is my decia~ation of Oomicile and Citizenship in the State of Florida that I am filing this day in aooordanoe and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of B rook 1 yn ~Is _ Mi ch i gan
. (Ciy) . (Staro)
and 1 resided at Wam~lers Lake Road . i~owever ~ have changed my domic3le
(Street and Numbe~)
b and am a~d have been p bona fide resident of tl~e State of Florida since 30 th day of
_TulX ,~9
6$, and 1 reside at 1800 Olean~er Ave.
(Street snd Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residente and domidle in the State of Horida.
(Insert he~e any perti~ent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, atc.)
FILED AND RECORDED
ST. IUCIE COUNTY. FLd.
R:=.+~O~G VERIr'FD
1'74636 ~
~
'69 FEB 10 dM 11:3
~o; E~ ~o~TR,~s
CLERK CIRCUIT COUF~T ~
I FURTHER GHtTIFY that 1 will comply with all other requirements of a legal resident of this State.
t FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanentiy.
. , ~
~ : . ' ~ (Name)
. ~ .J
~ ; -
. •
- ; , .
. ~ - • ~ - I800 Oleander Ave. , Ft . Pierce
v , (Address3
,
. ~ , ~
. -
" ~,.Swotn.io.and subscribed before me this i0 th day of Februarx , ~q 69
ROGER POITRAS
CLERK CIRCUIT COURT Notary Public
By . D.C. My ~ommiuion expires
Ro b~ ~x~cubd in duplicat~ and ori~inal Bl~d wilb C1~k Cirarit Cour~, and dupliat~ wilh Tsx Atat~or.)
BOUK~~S PAGE~IIV
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