HomeMy WebLinkAbout1613D~cfaratfon of Dor.~~~:~ and C:ii~en~~:fg~
TO THE STATE ANO COUNTY TAX ASSESSOR,
51. 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
.n conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of
wilbar
R. C.
(State)
(City)
and 1 resided at ROUte 2 _ __ However I have changed my domicile
(Street and Number)
ro and am and nave been a bona fide resident of the State of Florida since January 1 ~ day of
__ _ 19~_, and I reside at 2402 19th Street
_ (Sheet 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 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.)
Patsy Diane Sheets
enteriag child in public school)
FILED ANO RECORDED'
ST. LUCIE COUNTY. FLA.
itE CORC VERIFIED
18~~
'69 AUG 26 P 3:25
Q~~~
Foci= ~ ~o RHs
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 domiGle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
.f •
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4
C~
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~. Sworn_to and subscribed before me this
(Name) Shelby Sheets
(Address)
day of Augu8 t t 9~.
ROGER P0172AS
CLERK CIRCUl7 COURT Notary Public
gy .C. My Commission expires
eaoK i ~ly ~tlfi~ 1 -
(To be executed in duplicate and original filed with Clerk Grcuit C'our/, and clupliato with Tax AssQSSOr.)