HomeMy WebLinkAbout1118Declaration of Domicile and Citlsenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Si. IUCIE 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 A1~~lietgli~
(City)
NeM Mexico
(State)
and 1 resided at _. ~~~ 5316 Roae>.oat o N8 _. However 1 have changed my domicile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since __i~ ~S day of
19 69 and I reside at 1610 BostO>e
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(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 home, etc.)
Thoiass Lloyd Ltwtis
FILED ANp RECOROEO
ST, IUCIE COUNTY, FLA.
RF-COR! vERiF'!FO
,69 -181931
BUG 1 S pM ? : 55
ROGER POITRtig ~'
' CLERK 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 domicle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
(N ) Larry Lewis
(Address)
:~'` ~Svypprjt;tO'arid subsuibed before me this =s day of AVg , 19 6'
.~ ~ :CILEt~ CI~Cy1T COURT Notary Public
,..,
By. ~ r D.C. My Commission expires
,•~1. ':•
- ~ s-, .
Qo bo executed in duplicate and original filed with Cleelc Cirarit Court, and duplicate with Tax Atseaaor.)
No. 13
sooK1`l9 ~~1~~7
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