HomeMy WebLinkAbout0609 Declaration ot Domicile and Citizenship
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TO THE STATE AND COUNTY TAX ASSESSOR, 186[333
Si. LUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am fili~g this day in acoordance and
in conformity with Chapter 222, Section 222.17, Flo~ida Statutes.
Lake Zurich I11. ~
_ I was formerly a legal resident of
~C;y~ (State)
36 Miller Road
and 1 resided at Nowever I have changed my domiti~e
(Street and Number)
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to and am and have been a bona fide resicisnt of the State of Florida since 1St _ day of ~
_ October , 19_ 69and I reside at ~ispering ~rpPk Viliag~+,.~nt 259
(Street anc! Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be take~ as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
~(Inse~t here any peninent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, ett.)
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Fistablishing resideace
FILED AND RECORDED'
ST. LUCIE COUNTY. FLA.
~~CQa(1 VERirIED
-~~6033 ,
'69 NOV 21 ~ 9: 3 s
' ~~G~N POtTRAS
; C~ERF; CIRCUIT COURT
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I FURTHER CERTIFl( that I will comply with ali other requirements of a legal resident of this State.
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I FURTHER CERTIFY that I have no intention to return to my former domiu~e, and I intend to remain in FORT
PIERCE, SAINT LUCI~ COUNTY, FLORIDA, permanently.
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~~'.':-c':~~t ~ r• -
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~y.~~~ ~ •.i?S ~ ~ ,
; G. (Name) ;
= ~ = Robert ~1. Scott ~
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a tA e r. C. '.1 ' GC- Gl~'~ ~ wW
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" •'•;i ~C111e R~~CO'tt
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~ Sworn ~to ~and subscribed before me this 21St day of November , 19-b.4.
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~ ROGER POITRAS
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~ CIRCUIT COURT Notary Public
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~ By '~-`''~'L _ D.C. My Commission expires
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~ (To b~ sxenrted in duplicats and originsl filsd wjth Clerk Circuit Cou~, and duplicst~ with Tax Ass~s~or.)
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" 60RX ~~1 PAGE 6O~
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