HomeMy WebLinkAbout1589~aclaratioet 04 Oon:lciic~ and Cif~izehsi~i~ 1~8U
TO tHE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
.n conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a. legal resident of PCrt~ll~h Ohio
(City) (State)
and I resided at 1616 Grandvier+ Ave. However I have changed my domivle
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since 26t2i day of
Tune , 1q b9 , and I reside at 326 N. 15th St.
(Street and Number)
FORT PIERCP, SAINT IUCIE 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.)
(School Children)
Karen Lee - 9th Grade
FIl.EO ANO RECORDEl7~ ,
Teresa Lyon - 3rd Grade ST. IUCIE COUNTY.- FLA.'
` Ili=CORM VERIFIED
180
'69 AUG 26 PM I :33
RO':c? FOtTP.:+S'
CLERK CIRCUIT COURT
1 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 domicile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
Alfred T. urt
:.~` ~._. -. !~,.., (Name)
~, •. , ~.
~~
,' ~; X26 N 1 Sth St
'~ (Address)
^ `.- . ~•~ •~~n to and subsuibed before me this 26th day of A+~ Qu ct , ~ q_.6 Q_.
... ....
ROGER POlTRAS
CIRCUIT COURT
gy D.C.
Notary Public
My Commission expires
(To be executed in duplicate and origins! filed with Clerk Grcuit Court, and dupliate with Tax Assessor.)
so~K1'T9 x.587