HomeMy WebLinkAbout0780Oeclalratlon of Domicile and Citizenship 181669
TO THE STATE AND COUNTY TAX ASSESSOR,
S1. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Horida Statutes.
I was formerly a legal resident of Pi!ltiagtOa
(City)
and I resided at 604 west COlit>ebia
(Street and Number)
Missouri
(State)
However 1 have charged my domicile
to and am and have been a bona fide resident of the State of Florida since ~~ 8 ~Y ~
19~, and I reside at 1010 Pe». Avenue
(Street and Number)
FORT FIERCE, SAINT LUCIE COUNTY, FLORIDA
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 fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of hgrr-e, etc.)
Robest ~ willise, L3ada „~ Bsstaa
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I FURTHER CERTIFY that 1 will comply with all other requirements of a IeRal resident of this State.
I FURTHER CERTIFY that 1 have no intention to return to my fornner domicile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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r. -~ = '~ ~ 11th
Swern ~tio~..~nd subscribed before me this
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(Name) willitut B Bss»a
(Address)
day of August 19 69
Notary Public
My Commission expires
fiTo be executed in duplicats and oriflinai filed with Cle+~rk prcuh Court, artd dupliuh with Tax Asseeaor.)
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