HomeMy WebLinkAbout1124 Declaration ot Domicile and Citizenship
~ 1864i0
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TO THE STATE AND COUNTY TAX ASSESSOR,
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Sl. IUCIE COUNTY, FIORIDA:
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.
I was forrnecJ{~„a legal resident of _ w~?sh1~tOD _ D.C. ~
, (City) (Stab)
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and I resided at ___1~4~_P.Q*t Du~2nt Street S.B. However I have changed my domivle ~
(Street and Number) . !
to and am and have been a bona fide ~esident of the State of Florida since 6tb day of
October _ 19_b.4, and 1 reside at _-1511 A Bserald Terrace
~ (Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FlORIDA
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and this stateme~t is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Flo~ida. !
(Insert here any pertinent facts, s~ch as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Homestead
f~LEp AND RECORDEDi ,
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EaTF1ED
i ~6g OEC 2 ANI 10 ~ 3~ ~~O
i 186
~ n~LE~; ;•p~TRaS
~ CLERK ~~RCUIT COURT~
,
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1 FURTHER CERTIFY that I will comply with all other requirements of a tegal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. f'
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RGB 8 G
~ (Name) -
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1511-A Bnerald Terrace, Pt.Pierce
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; (Add~ess)
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~ ~ ' 2nd December , t9 69.
~ .~S~ivo~n;tu an9'~~subsuibed before me this day of
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~ - ~ ROGER- POITttA~-? = : ~
~ Nota Publ ic
fi CIR~U[~ iC~BR~
~ ry
~ - ' .
~ gy ' D.C. My Commission expires
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(To b~ executed in dupliute snd ori~insl ~ilsd with Cl~irk Cjrwit Court, snd dupliut~ with Tax Ass~ssor.)
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~ gooK181 P~E1123
No. 13 . . _
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