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HomeMy WebLinkAbout1604©eclaration o! Do:.::eaYe ~.:~~ Ciataen~~ip TO THE STATE AND COUNTY TAX ASSESSOR, ,- 182289 Sl. IUCIE COUNTY, FLORIDA: This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in acwrdance and in conformity with Chapter 222, Section 222.17, Florida Statutes. I was formerly a legal resident of ui~ri 1~ c Kentucky (City) (State) and 1 resided at 3719 Warren Avenue However I have changed my domicile (Street and Number) to and am and have been a bona fide resident of the State of Florida since ~ A -day of Ju1Y t9 69, and I reside at ~~ ~ ~'•+'' ~°*''- StrE•pt (Street and Number) FORT PIERCE, 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 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.) Bntering Children in School " FILED AND RECORDED ST. LUCIE COUNTY,- FtA.- RECORD VERIFIED 182289 '69 AUG 26 PM 2:43_ ~p~,ER rO1TR~g r CLERK CIRCUIT COURT. 1 FURTHER CERTIFY that 1 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, FLORIDA, permanently. ame~enry G. Davis (Address) Swarm .tp irid sy~~cfrtted before me this 2(+± t, day of s.~..a::~t , 19_b3. ,~~ ~~ ~.^ F ~ RC'+GEiI; - POITRAS ~ =; :- . ~:~ CLtiB~ ~1KCUIT COU ~ ~ Notary Public gy ~ ` O.C. My Commiuion expires .t.,..,:~t~~~ (To be executed in duplicate and original filed with Clerk Cirwit Court, and duplicate with Tax Assessor.) eoolc1 ~9 ~-c~~.6U~