HomeMy WebLinkAbout0643 Oe~laratlon ot Domicile and Citizenship ~-83'~5'7
TO THE STATE AND COUNTY TAX ASSESSOR, ~
51. WCIE COUNTY, fIORIDA: .
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in aooo~danoe and
in oonformity with Chapte~ 222, Section 222.17, Florida Statutes.
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i was formerly a legal ~esident of ~ Cli~tlOa pa. ~
(Ciyj (S1aro)
and 1 resided at - 94~ FOStlt St=!et Howevar 1 have chan~sd my domkile
' (Street and Number) ~
b and am and have been a bona fide ~esident of tha State of Florida since 4~ day of
September , ~q 69, a~ ~ reside at 11S No. lbtb. Street
(Street and Number) .
FORT PIHtC~, SAINT LUCIE ~OUN?Y, ~LORIDA
a:,:: this statement is to be taken as m~ declaration of citizenshio, actual legal residence a~d domicile in the State of Fiorida.
(Insert he~e any pertinent facts, such as sale of property or business, or relinquishment of employment
as former domicile, ~emoval of family to new domicile, purchase of home, etc.)
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BnrolQent of Child in achool FILEO AND RECORDED ~
ST, LUCIE CQUNTY. FLA. (
R; ~`Q?,[' V~RIFIFD ~
l83`75`~ ~
DIANB CRONHdOVBR 1S q~e ars ,~gg O~T i AM I I: 31
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~:0~*~R r OITR~S
Cl.ERK CiRCUIT COURT
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1 RJRTHER ~HtTIFY that I wiil aomply with all other requiremenri of a(s~el resident of this State.
1 FURTHER CE12TIFY that I have no intention to retum to my former ic.ile, and t intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~ f
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~t. RAY~DND CROi~idOYBR ~
- (Name)
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: - - ~ 113 No• 16th. ~treet .
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~ ~ . Pt. 1~'l~E~, Plosids 33450
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~ Sworn to ~nd subscribed before me this 1st day of ~tObC! ,~q 69 ,
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- Koc~He romus
CLERK CIRCUR COURT Notary PuWic
By D.C. My Commiu'ron expires
(To b~ uaculyd in dupliub and ori~inal fil~d witi~ CiKk Uraiit Carrt, and duplicah wilb Tax A~
)
BaoK 180 64~.
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