HomeMy WebLinkAbout2770Declaration of Domicile and Citlzelnship
183115
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FLORIDA:
This is my declaration of Doricile and Citizenship in the State of Florida that 1 am filing this day in atoordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
Pontiac Michigan
I was formerly a legal resident of
(City) (Stara)
and 1 resided at __ 4679 Latier161if Drive _ _, 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 1st _ day of
SeptC®ber ~ Iq 69 ,and 1 reside at
2109 South 29th street
(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 Stara of Florida.
(Insert here any pertinent facts, such as sale of property or busineu, or relinquishment of. employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Bntering Dean in the 9th grade
~+ David in the ?th grade
FILED AND RECORDEDt'
ST. LUCIE COUNTY. FLA.'
RECORD VERIFIED
183115
'69 SEP 17 AM 8:5,7
~&%C/
ocen rol ~ Res
CLERK CIRCUIT CQURT)
1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
1 FURTHER CERTIFY that I have no intention to return to my former domicile, and 1 intend to remain in FORT
PIERCE, SA~(VT,~~J~E COUNTY, FLORIDA, permanently.
:~ ~-
(Name)
= ' -- r - ~ . Brnest Lwek
~^ , ..
~;
~4~:. (Address)
..... ~~
'' ~ _. Ct''~:
Sworn to and subscribed before me this 17th day of September ~ 19 69
ROGER POITRAS
CIIICUIT COURT
gy ~ e.2~ ~[..e.~G~- D.C.
Notary Public
My Commission expires
(To be executed in duplicate and original filed with Cleric Grcuit Court, and duplicate with Tax Assessor.)
=~~ BOOK179 Pw~2768
No. t 3