HomeMy WebLinkAbout1774 oeciaratlon ot Domlcile and Citizenship 18463p
TO THE STATE AND COUNTY TAX ASSESSOR, .
Sl. IUCIE COUNTY, FIORIDA: -
This is my decla~ation of Domicile a~d Citizenship in the Stata of Florida thst 1 am fili~g this day in acoo~daROe and
in oor~formity with Chapter ~22, Sectio~ 222.17, Florida Statutes. ~
I was formerly a legal resident of ~nAli~l~$ 1~linn_
(City) (Stste)
i
and 1 ~esided at _?615 Alabamit A~e. SOUth . However 1 have changed my domidle
(Street and Numbe~)
to and am and have been a bona fide resident of the State of Florida since 2 8th day of
August - 69 310 Hoily Ave.
, 19 , and 1 reside at
(Street and Number) . ~
~
FORT PIERCE, SAINT L~1CIE COUNTY, RARlDA - ~
and this statement is to be taken as my declarotion of citizenship, actual legal ~esidence a?~d domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of p~operty or busineu, or relinquishment of employment ~
at former domicile, removal of family to new domicile, purchase of home, etc.)
Bstablishing residence
. FIL~O AND RECOR~EO
ST. LUCIE COUNTY. FI.A.
1~~~_ ~~i ^ RIF1~D
.~s4s3o
'69 ~rT 22 P~! ~2: OZ
~
.,;1~~~ f? ;~p~TR:.S
CLERK CIRCUIT COURT
I
~ -
I
1 FURTHER CERTIFY that I will comply with all other requiremenfs of a leyal residant of this State. ~
1. FURTHER CHtTIFY that 1 have no intention to retum to my former domicjle, and I intend to remain in FORT-
PIERCFtl~{~~lUC1E COUNTY, FLORIDA, permanently.
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Sworn to and subscribed before me this 22nd day of ~t~ ~ jq 69 .
ROGER POITRAS
CIRCUIT COUItT Notary Public
Q~-~ ~ ' O.C. My Commiuion expires
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(To b~ ~x~cubd in duplicat~ and ori~ii+al fit~d whb Cl~h Cira~t Cou~t, and duptiut~ wilb Tax A~a~or.)
BOOK 10O PAGE~ ( ~
No. 13
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