HomeMy WebLinkAbout0778Declaration of Domicile and Citizenship 18166`7
TO THE STATE AND COUNTY TAX ASSESSOR,
S1. lUC1E COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in aoxrdanoe and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of GHORGL
(City) (State)
and I resided at _~0~1. ~tehu ~~e- _-. However 1 have changed my domidle
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since lad day of
anst t9~~, and 1 reside at 3S7 TabMaton Street • Pt _ Pierce _ Fia,
(Street and Number)
FORT MERLE, SAINT LUClE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Honda.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
DBBM11 LBItgi Jo>~1sTO~t is years age
CHARLES DUANB JOIEiNSTON 11 yetuca~
TERRY BW~lB J~NS'I~CH 10 years
MICS<~IABL GARRY J~13TaN 13 years
ath grade
Sth grade
4th g=rid FILEO AND RECORDF A.
esT, LUCIE COUNTY.
RECORC VERIFIED
lad grade irn ~ p~
'69 AUC II AH/11:03
i8166p'7
ROLER t'UfTf,t+5
CLERK CIRCUIT COURT
1 FURTHER CERTIFY that I will comply with all other requirements of a legal teaident of this State.
I FURTHER CERTIFY that 1 have no intention to return to my former domicjle, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. t ~ ~ Q~
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w: 3S? Johaston Street, Pt. Pierce,
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~ ,~iggi'~nd ~giibscribed before it
me this day of ~tat~
, 19
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ROG~ POITRAS
CIRCUIT COURT Notary Public
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~ D.C. My Commission expires
y
(Te re execvtod in duplicate and original filed with Cleric Circuit Court, and duplicate with Tax Armor.)
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