HomeMy WebLinkAbout1713Deciaratloln of Domicile and Citizenship'
TO THE STATE AND COUNTY TAX ASSESSOR, 1~~
Sl. IUCIE COUNTY, FLORIDA: `~
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in acoordante and
in conformity with Chapter 222, 'Section 222.17, Florida Statutes.
1 was formerly a legal resident of _ Mnn* aomerv Alabama
(City) (State)
and 1 resided at Rt . ~ 1 BOx 289 _. However I have changed my domicile
(Street and Number)
ro and am and have been a bona fide resident of the State of Florida since 1St day of
_ August ~ Iq 69 ~ and I reside at 112 Gardenia
(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 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.)
(School Children)
David Allan - 3rd Grade
FII,E_p AND R~ef~D~Q
Darr 1 Dee - lst Grade ST, LUCtE C~01~)'1~Y•. FLA.
y ~<~cerc~ VEI?II`~t=D
182~5~
'69 ;~n~ 2$ PM 12.58 ~
°D
CLERK C1r~CU1T CQURT
I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this Stab.
1 FURTHER CERTIFY that I have no intention to return to my former domicile, and 1 intend to remain in FORT
PIERCE, SAINT LUGIE COUNTY, FLORIDA, permanently.
..;1~a11f~i1!'-ti , I ' ,rBgrd
- /'
.. ,._, z. - - _-
'~ ~ - 112 Gardenia
' _ -:, 1 ••-: (Address)
;-. ~ ~ .'
.. ~~~~
Sworn to and subsuibed before me this 28th day of -~tgr~st , 19-~•
ROGER PORRAS
CLERK IRCUR COURT
gy ~ D.C.
Notary Public
My Commission expires
Ro ~ executed in dupliub and original filed with Clerk Cirwit Court, and duplicaN with Tax Asaaaor.)
No. 13
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