HomeMy WebLinkAbout2135 Deciaratio~ of Domicile and Citizenship 17'464~ ?
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TO THE STATE AND COUNTY TAX ASSESSOR, , ~
51. LUCIE COUNTY, FLORIDA: '
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This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in aooorda~ce and j
im m~fo~mity with Chapter 222, Section 222.17, Flo~ida Ststutes. ~
I was formerly a legal resident of Roelle Park _j~j~.w Jg~~~l f
(Ciiy) (State) +
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and 1 ~esided at d?9 Hemlock St=wat However I hsve changed my domitile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since 3 S~t day of
JulY__-. , 1968 , and I reside at 2602 Ave B.~ Pt. Pierce _
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domitile in the State of Horida.
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(Insert here any pe~tinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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FILEO AND RECORDED :
ST. LUCIE COUNTY, FLa. ;
~F~C~n V~RIFtED
~ 1'74648 ~ ;
69 FE6 10 PM 2: I
~ iiOr~P, POITRAS
k _ CLERK CIRCUIT COURT `
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1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domiG~e, and I intend to remain in FORT ~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ ~i~?~/ ~J' ~~~`t/
' - ~ AI`NA M. FANIA
. ~ . _ (Name)
- - : ;
- - ~ - f
~ ~ 2602 Ave. B., Ft. Pierce ~
~ ~ ~ _ (Address) f
" "4'-.' ~
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,Swom to and suburibed before me this lOth day of FebELarv ,~q 69 ~
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ROGER POITRAS
CIERK CIRCUIT COURT ~ Notary Public
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~ 8y D.C. My Commission expires
' (Ts b~ ~xacuttd in duplluh and ori~i~fi~~d~iilh Cl~j_~ Court, and dupllut~ wifh Tax A~s~or.)
~ BG~K L ( ~7 PRGE ~
Wo.
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