HomeMy WebLinkAbout2985Declaratlo~ of Domicile and Cltlzenship -183'3
TO THE STATE AND COUNTY TAX ASSESSOR,
Sj. IUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and '"'
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of Grand Rapids Mich.
(City) (State)
and 1 resided at 1314 1rtA~rdc IJfl However I have changed my domidle
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since 1Sth _ day of
Sente~ber 14_x, and 1 reside at $haf ner llbtel
(Street and Number)
FORT MERLE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State 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)
T Ina Ann -Grade 11th
Sheree Lgnn - 10th Grade
Michael Alan - 8th Grade
Ronald Lee - 6th Grade
Steen Ben - 3rd Grade
,n
FILED ANO RECORDED
ST. LUCIE COUNTY, FLA.
i:~n:,r. ~:~RiFsEv
1832'73 _
~~g ~~? 22 AM !0:1.6
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~;OvE R ~•OITR
CLrRK CIRCUIT COURT
I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this Stste.
1 FURTHER CERTIFY that 1 have no intention to return to my former domicGle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
W
-~~ ,~ - ~~~ Shafner Motei
~' J - , - ~ ~l (Address)
• ~ y .
,_
.,^~ .t~alttd subscribed before me this 2~ day of Se; temi~er fq 69
;_ ~-;~~ .
ROGER F'OITRAS
CIRCUIT COURT
i3y D.C.
Notary Public
My Commission expires
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(To be executed in dupliub and original filed with Clerk Circuit Court, and duplicate with Tax Asseaor.)
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