HomeMy WebLinkAbout1456Declaration of Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in eocordanoe and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of
and 1 resided at 415 Beech Ave
Uloodburq Heights
(City)
(Street and Number)
rt. J.
(State)
However I have changed my ~domic3le
to and am and have been a bona fide resident of the State of Florida since Augtt~t 12 day of
19 69, and I reside at 3446 SO. pines Drive
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIOA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the Stab of Horida.
(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.)
Bstablishing residencq and citizenship
~llEO ANO RECORDED
ST. LUCIE COUNTY, FLA.
18217'1
'69 A(,sG Z 2 PM 2 : S
a~J
~~
CLERK CIRCUIT COURT'
I FURTHER CERTIFY that I will comply with all other requiremenri 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, FLORIDA, permanently.
f~"~
(Name) Theodore W Clark
~ ~ ~ . ~~
~~i Helen M Clark
- •SV~or»,t0:5s~ifl;~vbscribed before me this 22 day of AugLtst ~ 19 69
~~ .
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- CL~K,CtRCt1R! URT Notary Public
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By -• _ ~ D.C. My Commission expires
=.Cfl• .
Ro be executed in dupliuh and original fled with Clerk Circuit Court, and duplicate with Tax Assessor.)
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