HomeMy WebLinkAbout1462 Declaratio~ ot DomiCile and Citisenship ~
1~~;b5~ ~
TO THE STATE ANO COUNTY TAX ASSESSOR, 1
~
,
"t
Sl. LUCIE COUNTY, FIORIDA: ~
~
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in acoordante and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was former~y a legal resident of -_~__~L~II-_ Alew .Jeraev _
tCiy) (Staro)
23 Tauton Ave.
and I resided at Howevef 1 have changed my domicGle
(Street and Number)
i
to and am and have been a bona fide resident of the State of Florida since day of ?
_ Decp.mbes _ , 19 69, and 1 reside~71 So~s A~e•
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this stateme~t is to be taken as my declarotion of citizenship, actual legal residence and domicile in the State of Horida.
(Insert here any pertinent fact;, such as sale of property or business, or relinquishment of employment !
at former domicile, removal of family to new domicile, purchase of home, etc.)
$nterieg children io school-
FILEO AND RECORDED'
ST. LUCI~ COUNTY. fLA.
R= CORC VERIFIED
Debra in the llth grade 18665~
Jo Ann ia the 8th grade '69 OEC 6 AM I I: 0 ~
;
paul G. in the Sth grade ;p :~p 'plTRAS
CLERK CIRCUIT COURT
I ~
E
tt
1
I FURTHER CERTIFY that I will comply with all other raquirements of a(egal 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.
: • " '~'ir~~ . ,
: ' ' - ~
~ . • C ~ (Name) ;
~ : • _ George p• Hiers ~
a • , ~
~ . '
~ . . ,
~ - . ' - (Address)
~ - ...p'''' 4`!
~ ~~'~Sworn to~and subscribed before me this $th day of ~c~~r , 19 69 ~
~ ~
~ ~
~
~ RO~iER PORRAS ~
~ CIRCUIT COURT Notary Public
~ By D.C. My Commission expires
~
~
~ (To b~ ~x~cuted in dupliuts snd o~yinal filed with CIKk Grcuit Court, and duplicah. wjth Tax Ass~s~or.)
~ d00!(
~ 0 R PJI~E~~V~
~ r~o ,1
~ r~- ` ~ ~
, , ;
~~~~'._.~~sr-:a.~~"`~ ~;'~.a'..._. a .