HomeMy WebLinkAbout0146 Declaratlon ot Domicile an~! Cittsenship
183411
TO THE STATE AND COtINTY TAX ASSESSOR,
St. LU~IE COUNTY, FLORI~A:
~hi~ is my dedaration ot ~omicile and Citizenship in the State of Florida that I am filinQ this day in aooordsnos and
in aonformity with Chapter 222, Section 222.17, Fio~ida St~tutes.
1 wss formerly a legal resident of New York New YQrk
(City) lStste)
and 1 rosidad at 2Z A.rden S t. . However 1 have chanQed my domic~le
(Sheet and Number)
ro s~d em and have been a bona fide rasidant of the Stats of Florida since 23rd day of
JUly , 19 69 , and 1 reside at 2868 Mourningside Blvd.
- (S~treet and Numbsr) (po=t St. LuCi!
FORT ~I~G~, SA{NT LUC1E COlINTY, ROR1~A
and thi: statement is b be taken as my declaration of citi=enship, actual legal residenta and domidle in fhe State of Horida.
pnsert here any pertinent facts, such as sale of property or business, or reli~quishment of employmsnt
at former domicile, remova! of family to new domicile, purchase of home, etc.) -
.
(Homestead Bxemption)
FtLED AND VNTYpF
pp,.'
ST•~UCp~p VERIFlED -
183411 .
'69 SEP Z3 p~ 3q ~
.
~oG~~ Fo~T ~ovR?~ - .
CLERK CIRCUIT
i FURTHER CERTiFY that 1 will aomply with all other requirernents of s le~a) resident ofi thls State.
I FURTHER CERTIFY that 1 have no intention to ~eturn to my former domiG(e, and I intend to ~emain in FORT
~ PlERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. JOh1] R. Ec Marie L. Ford
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; = (Name)
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. . 2868 ~ourninasi4~~Bivd_
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• y ~ 23 rd
.::..Swcx~1 ~To and subsuibed before me this day of S~ittember ~q~Q_,
Y
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' CIRtUR CO Notary Pubiic
~
BY ~ D.C. My G~mmission expires
~ (Te b~ ~oc~eul~d ie duplical~ and ori~n~ fil~d wi~h Claic Cirwit Court, and duplkat~ wilh Tax Aau~or.I
eomc~~ n~
Nc. 13
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