HomeMy WebLinkAbout0422 ~
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Decia~etion ot Don~icil• and Citisenship ~
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TO THE S?ATE AND COUNTY TAX ASSESSOR,
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51. UKIE COUPlTY, FLORIDA:
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This is my declaration of Domicile and Citizenship in the State of Florida that I am fili~g this day in sccordsnos and
in oonformity with Chapter 222, Section 222:17, Florida Statutes.
I was formerly a legal resident of Clarion Iowa
(CitY) tState)
101? First Avenue, SW '
and 1 ~esided at _ However 1 have changed my domicile
(St~eet and Number)
to and am and have been a bona fide resident of the State of Florida sinoe September ~ day of
_ _ , 19
68 , and I reside at 3423 A~bo t t St te et ~
(Street and Number)
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FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual lega) residence and domicile in the State of Horida.
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
for homestead purposes and establishing residence
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1'755~
'f:LEO AHD ~EGORD ~D
Sj~RECORO V~R
f ~1
~ 1,~9 ~AR I 2 PM ~ 3
~ ROGER PD?TRAS
CLERK CIRCUIt COURT
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I RJRTHER ~HtTIFY that 1 will comply with al) other requirements of a legal resident of thia State.
I FURTHER CERTIFY that I have na intention to retum to my former domiCile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORI~A, permanently. .
i/ 0-~2~~1 V1/
• (Nsme) ~ nard Mosher ~
(Address)
Sworn to and subscribnd before me this 12 ~y af ~ rCh ~ 19 69
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ROGER ~ORRAS f
- Gt~RK CIRCUtT COttRT Notary Public ~
gy D.C. My Commission sxpires
(T~ w~c+r1~d ih d~plic~h and ai~inal Al~d whb C~ek Cira~it Ceue~, and drpliat~ whb Tatt A~~.l
176 ~ 42ii ~
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