HomeMy WebLinkAbout0157 ~
Declaration ot Oomicile and Citizenship ~ ~
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl, IUCIE COUNTY, FLORIDA: ,
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This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
~n rnnformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of DuY'~181~~., C. _
(City) . (State)
Route 7 Boa 93 Durham N.C.
and 1 resided at _ _ _ _ _ _ _ ~ - ~ _ . _ _ However I have changed my domicjle
(Sireet and Number)
to and am and have been a bona fide resident of the State of Florida since S@~embel" day of
~J, `
, 19~-, a~d 1 reside at 604 S outh 6th Street
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to t~e taken as my declaration of citizenship, actuat legal residence and domicile in the State of Florida.
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(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.)
Esteblishing residency , '
F~LED AND RECORDED `
Canadian Citizen - ST• LUC~E COUN7Y, F~A,
`-".!'Or..^. VERIFIF
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'69 NOU I 4 PM I: 33
1856~0
`?~G=?i ~~OITRt,S
CLERK CIRCUIT COURT'
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~ I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
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~ 1 FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT '
~ PIERCE, SAINT IUCIE COUNTY, FLORIDA, permanently.
~ ' . ~ 7~ ~
~ . , 2~~.ud~ ~ ~ ~
~ . i•-_1 (Name)
~ ~ . Gertrude Iwan~uk
~ - !
_ ,
~ (Address)
~ ~ , 14th ~ Hovember 69
- Sworn to and subscribed before me this day of , 19 .
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_ ROGER POITRAS
_ CLERK CIRCUIT~OURT Notary Public
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~ 8 O.C. My Commission expires
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~ (To be executed in duplicate and originsl filed with Clerlc Circuit Cou~, snd dupliuts with Tax Asssssor.) ~
~ OR ~
No ~a
BooK 181 PACE 157
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