HomeMy WebLinkAbout2679 ~eclaration ot Don~icits and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, ~
Sl. IUCIE COUNTY, FIORIDA: ~
This is my decla~ation of Domicile a~d ~itizen:hip in ths State of Florida thst 1 am filing this day in stoordanoe and
i~ oo~formity with Chapter 222, Section 222.17, Florida Statutes. ~
W@8tOY1 E
I wat forme~ly a legal resident of L~n~ • t
(City) (State) . t
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Glory Road ~
and 1 resided at _ . However 1 have tha~~ed my domi~ile ~
(Sneet and Number)
to and am and have been a bona fide resident of the State of Florida since ~~v. 16 dsy of
, i9 68 , and ~ reside a~ Koute 2 Boa 3315 - l+t. Pierce Blvd
(Street and Number) - -
FORT PI~CE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citi=enship, actual lega) residence and domidle in ihe State of Horida. ;
(Insert here sny pertinent facts, such as sale of property or business, or relinquishment of employment #
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st former domicile, removal of family to ~ew domicile, purchase of home, etc.) '
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Establishing residency -
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V~ E C~v~CORDED
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E~~Q.
S~os
~69 FEB 2 ~~y i l:
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f CIERi( C~R~UIT COVRT ~
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I FURTHER CERTIFY that 1 will oomply with all other requlremenfs of a le~al resldent of this State.
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1 FURTH6R CERTIFY that I have no intention to return to my former domiCile, and 1 intend to rem~in in FORT
PIERCE, SAINT LUCIE COUNTY, fLORIDA, permanently.
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";;;.;•:;ti'=::' Mame~ Herbert E, Sm th
,i 1 • t~i ' ~ , '
~ .i''+ ~.`~;,i_~G ~ , -
~ ~'d:a ~ ~ - (Address)
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~~:'to and wbscribed before me this 21 ~y of February , ~q 69 }
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CL~K CIRCUIT COURT Nofary Public
By ~ D.C. My Commissio~ expires
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~ (T. b. uuarMd in d~rp~c.~. .nd .~i~inal tiNd wiN~ a.ek ckc~if cewt, .ud duplic.~. will~ T.s A...M..a
~~i~5 ~2674
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