HomeMy WebLinkAbout0259 Declaration ot Domicile and Citisenship
TO THE STATE AN~ ~OUNTY TAX ASSESSOR,
Sl, tUCIE COUNTY, FIORIDA: ~
This is my declaration of Domicile and Citize~ship in the State of Florida that I am filing this day in aooordanos and
in oonformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legat ~esident of Sbaroa Tenn
' (City) (Sfets)
Box il • S6aron ~ ~
and 1 resided at - However 1 have changed my domic3le
" (Street and Number)
to and am and have been a bona fide resident of the State of Florids sinoe ~9 Zl day of
~ , 1969 , and ! reside at 65? NO. 2Od StteE~t
(Street and Number)
FO~T r1ERCE, SAINT LUCIE COUNTY, FLORI~A
and this statement is te be taken as my declaration of citizenship, actual legal resid8nce and domicile in fhe State of Horida.
(Insert here any pertinent facts, such as sale of property w busineu, or relinquishment of employment
at formar domicile, removal of family to new domicile, purchase of home, ett.)
Bstablishing reaiden~y
FtLEO AND RECORD~di
S7.RECORD vuRIFIEO`A.
`1~~9~
~69 ~uN 9 ~ ~ y8
i'~~ E~ ~o~TRas
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, CLERK CIRCUIT COURT3
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~ I RIRTHER G~RTIFY that I will comply with all other requirsments of a la~al resident of this State.
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t FURTHER CERTIFY that I have no intention to retum to my former domiGl~, and I intend to remain in FORT
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j PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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Name) Bett~ Southatd
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(Address)
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Sw~~a ~nd;'wbsuibed before me this 9 day of Ju~e , 14 69 .
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~ ~ ' ~~~,RIL C{RC~IfY COURT Notary Public
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By • O.C. My ~ommission expires
~~y.~
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R~ w~~arl~d ~~uN and ori~inal fil~d witb Cl~rlc Cirarif Ceurt, and dvpi~csN wHb Tax A~o~a
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~178 ~
Flo. 13
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