HomeMy WebLinkAbout0812Declaration of Domicile and Citizenship
.t82~
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 accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of ~.;~a'~~ yam" v s~
(City) (Ste»)
and 1 resided at --~~ ~ •°~ *~" ~ Rd. However I have changed my domicle
(Street aril Number)
ro and am and have been a bona fide resident of the State of Florida since aDd ~Y ~
Auacust 19_x, and 1 reside at la0 ~sid~ia Rd. Post St. Lucie
(Sheet and Number)
FORT PIERCE, SAINT itUC1E COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the Stab of Florida.
(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.)
(School Children)
811en Ann - 16 years
Flt_Ep AND RECORDED
ST. IUCtE COUNTY, FLA.
"`` Haan ~'ER1FlE0
'69 Que i ~ ~81~~
PM 2 : y3
Q
~Q:,~ R ~ 41TR:.g
Ct_~RK CIRCUIT COURT
I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently.
. ,. `1
. - - ~ y; f; (Name)
i ~.
~~~-1 ~ ,
~ ~~"_ , ' (Address)
. 4' ~~ r:
C f ~ • `.Sworn to and subscribed before me this 11th day of Aug~lit , 19 69,
ROG~ POITRAS
CIRCUIT COURT
gy ~ D.C.
Notary Public
My Commission expires
(To be execvbd in duplicate and original Bled with O rlc Cirwit Couef, and duplicato with Taac Awaaora
a~K179 ~ g~
~- „ - -
~~Jr _ -__._ __.___ ,_.- -_ _ _ - f