HomeMy WebLinkAbout2781Declaration of Domicile and Citlsenship
TO THE STATE AND COUNTY TAX ASSESSOR,
183125
Si. IUCIE COUNTY, FlOR10A:
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 _ H ighland Park
(City)
2655 Marl Oal~ Drive
and 1 resided at _ _
(Street and Number)
I11.
(State)
However 1 have changed my domicile
to and am and have been a bona fide resident of the State of Florida since 8th
Aeptember
19 69 , and I reside at
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
2161 S.B. Santa Mita3treet
day of
(Street and Number)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Fforida.
(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.)
Bstablishing residence
FILED AND RECORDED
ST, LUCIE COUNTY. FLA.
~83~2S
- 69 SFP t7 AH II: 52
'iCt'~E=? r'OITt~P.S
CLERK CIRCUIT COURT
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 domit)le, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
:,,:.::usr;:.
~. '' ~ cc,,
- ~,, :t, _- .'~=~~ ~-~__ - Gorge ryNar$e Manahan r.
;~ :;~: -. " - r--, :~ (Address)
U •... •••~ ,, ,
','I, n! ~ .. ~ 17th September 19 69
-sworn to and subscribed before me this day of -
ROGER POITRAS
CIRCUIT COURT
By °`~''~ t'L ~ D.C
Notary Public
My Commission expires
(To be executed in duplicate and original Bled whir Clerk Cirwit Court, and duplicate with Tax A~esaor.)
gsoK1~9 PA~2"< r9
No. 13