HomeMy WebLinkAbout0912 Declaration ot Domicile and Citizenship
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TO THE STATE AND COUNTY TAX ASSESSOR, '
Sl. IUCIE COUNTY, FLORIDA: j
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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 ~
in conformity with Chapter 222, Section 222.17, Florida Statutes.
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I was formerly a legal resident of
(City) (State) ~
and I resided at ROUte__~l,~patriot, OhiO However I have changed my domitile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since ______bth day of
_ MatCh_ , ~q 69 , and t reside at __?08~ South 30th Street
(Street and 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 Florida.
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of ~employment ~
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at former domicileb, removal of family to new domicile, purchase of home, etc.) ~
Homestead FILEO AND RECORDED~
ST. LUCIE COUNTY, FLA.
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CL~RK CI~CUIT COURT~
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" I FURTHER CERTIFY that I wil) comply witfi all other requirements of a lega) resident of ihis State.
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I FURTHER CERTIFY that I have no intention to return to my former domiCile, and I intend to rerrtain in FORT }
~ PlERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. t
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~ ( I~t . ) OiAKLBY E . HARBOLT
~ (Name)
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208~ So. 30th. Street, Pt. Pierce,Pl. :
(Address)
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_ ~ '~Swocii'to,~~~subscribed before me this 28 tb day of No~ember ~ 19 69 ~
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' ROGER' rQITRAS
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- ' GR~~U(T,.COURT Notary Public
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= By ~ D.C. My Commission expires
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~ (To b~ sxecuted in dupliute snd original filsd whh Gerk Grcuit Court, and dupliut~ with Tax Ass~s~or.)
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