HomeMy WebLinkAbout0611 Oeclaratio~ ot Domtcile and Citize~ship
TO THE STATE AND COUNTY TAX ASSESSOR,
ST. IUCiE COUNTY, FIORIDA: ,
This i~ my decla~ation of Domicile and Citizenship in the State of Florida that 1 am filinq this day in acoordance and
i~ oonfo~mity with Chepter 222, Section 222.17, Flotida Statutes.
1 was formerly a legal resident of Battl@ Creek Michi~an
(City) (StaM)
and 1 resided at ~oute 1~4 Box 112 . However I have chanqed my domiqle
(St~eet a~d Number) ,
ro and am and have been a bo~a fide resident of the State of Florids since ~nth day of
SeFtember ,~q64 , a~ ~ reside ar Rt. 1, Box 143, Ft. Pierce, Fla.
(Straet a~d Number)
FORT PI~CE, SAINT LUCIE COUNTY, FLORIDA -
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the Stab of Flo~rida.
(Insert here any pertinent facts, such as sale of property or busineu, or relinquishment of employment
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at former domicile, removal of family to new domicile, purchase of home, etc.)
~ fillED AFtb RECOROED
ST. LUC1E COUNTY, F~b:
. «ECOR~ VERIFIED
1`75689
'~9 MAR I 7 AM 10 : 52
'~0~~~ ~OITRAS
CLERK CIRCUIT COURT
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~ 1 RIRTHER C'ERTIFY that i will oomply wlth al) other requiremenri of a Is~el ~eside~t of thi: State.
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1 FURTHER CERTIFY that i have no intention to retum to my former domicjle, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ W. H. ^vILBfiRT
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` Rt. 1, Box 143
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~ (Address)
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~ Sworn to and subsuibed before me this 17th day of March ~q 69 .
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ROGER ~OlTR~1,S..'~
C1~tj~.~O11RT'-. Notary Public
By D.C. My Gommiuion expires _
. . 3 i :`C -
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(Te b~ ~gfi~'~p• ~~d o~i~inal Al~d wi1i~ CIMic Circ~ril Cooe~, and dvplieal~ wiTh Tax A~~J
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