HomeMy WebLinkAbout0488 Declaratlon ot Oon~icile a~d Ctttzenship
TO THE STATE AND COUNTY TAX AS.SESSOR,
Si. IUCIE COUNTY. FLORIDA: ~
This ~s my declaration of Oomicile and Citizenship in the State of Florida that 1 am filin~ this day in sooordano~ and
in conformity with Chapter 222, Section 2Z2.17. Florida Statutes.
~ Louisville ~ Ky
1 was forme~ly a legal ~esident of
(Ciy) ~State)
and 1 ~esided at ?904 Bramble ~ane ~Wever-1 have chanped my domi~le
(St~eet and Number)
to and am and have been a bona fide resident of the State of Florida since MaxCh 16 day of
, ~9 69 , and I reside at 110 NO. 40th Stfeet ~
(St~eet and Number)
FORT PIERCE, SAINT IUCIE COUNTY, PLORIDA
a~d this stateme~t is to be taken as my declaration of citizenship, act~al legal residence and domicile in ths State of Horida.
(Insert here any pertinent facts, such as sale of property or business, ar relinquishment of employment
at former domicile, removal of family to new domicile, purthase of home, etc.) .
Placing children in school
1'75591 ~
~ FsLED AND t~ECORDEO
- ST.REC0~0 VERIFIEjt.`1. ~
I~lo9 i~~li~ i 3 PM
~ ROGER POITRAS ~
CLERK CIRCUIT COURT
.
~
I FURTHER CERTIFY that 1 will oomply with all other requiremenis of a leyal resident of this State.
I fURTHER CERTIFY that 1 have no intention to retum to my former domi4le, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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(Name) Ra lph . Coo pe r
~
~
~ , (Address)
~ . . .
~ c~i~i ~
u~,-;:;Swocn to anc~ subsuibed before me this day of „ -/-f , 19
~ . .
. ~ ~ = - . . , • .
. ' RQGEIC ~~013qA3
CLERK'.CIR • t ~COURT Notary Public ;
~ . '
~ 8 ' . , / D.C. My Commission expires ~
y • . x
€
. ~
(Te b~ ~x~cuNd i~ duplicab and oripinal K{~d wilh CI~~lc Cirwit Co~N, and duplicat~ with Tax Ass+s~or.)
- ~i?6 ~ 48'T
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