HomeMy WebLinkAbout1460 Deciaration ot Don~icile and Cittzenship
TO THE STATE AND COUNTY TAX ASSESSOR, ,~,BO~iV6
Sl. lUC1E COUNTY, FLORIDA:
This is my declaration of Domicile and CitiZenship i~ the State of Florida that 1 am filing this day in aooordante and
in oonformity with Chapter 222, Section 222.17, Florida Statutes.
Toraca
1 was formerly a lec~al ~es~d~,t of - T~~~i N• 'j•
. (Ciy) (Staro)
and 1 resided at 18 BO! t I.ts1! _ . However 1 have changed my domiG~e
(Street and Number)
to a~d am and have been a bona fide resident of the State of Florida since JuDe ZO day of
, 19
69, and I reside at 2947 Ssn $eroni~ Rd~
(Street and Number)
FORT PIEltCE, SAINT LUCIE COUNTY, RORIDA
a~d this statement is to be taken as my declaration of citize~ship, actual legal reside~ce and domicile in the Stab of Horida.
(Insert here any pertinent fads, such as sale of property or busineu, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
8stablisbin~ residencq
F~~Ep AND RECOROEO
5?. I.UC~E ~ OV RIFtE~LA
pc C('R=:
80~ • 5
'69 ~f`~ 3~ p~ !2 '
I ,
~
i _ . o~S~nS
f CtERK CIRCU{T COURT
f
f
~
~p
k
~ 1 RIRTHER CERTIFY that 1 will oomply with all other raquirements of a Isyal resident af thi: Stste.
I FURTHER CERT-IFY that 1 have no intention to retum to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
.
~ t~ ~~s
~ (Name) LOUii 1Cernohan
~ -y, - ,:~•~.•v.
~ ~ ~ ~
~ _ - r, ~ . - '
~ _i ~ - (ae~rtet) Lolita 8. jCeroohaa
' . ~ ~ y
~ - ~x . .
~ . ~
.
~ =;'-i . .
~ :~wo~i io and~vbsuibad before me this 3U day of JV~! ~ 19 69
~ . T: _
Jr X~`
J_r~il~~ ~
~ ` #O@i~'• lORR~A~
~ CLEAC Ci~GIlR COURT Notary Public ,
~
~
~ 8y ~ D.C. My Commiu"wn expires
~ (To b~ uacvhd in dupllcat~ and o~ginal Rl~d wilb CIKk C'ira~il Couet, and dupliatr wilh Tax Awt~or.)
eoo~1 ~~~1459
~ - _
-Y ~N~
~ 4~~* _n . - ~
~~`~s~-~~~