HomeMy WebLinkAbout1976 - Declaration ot Domicile and Citizer~ship
TO THE STATE AND C~UNTY TAX ASSESSOR, ~
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Sl. LUCIE GOUNTY, FIORIDA: 1H IOJ ~
This is my declaration of Domicile and Citizenship i~ the State of Florida that I am filing this day in acco~dance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of ,~!fE~ . ;
(CitY) (Sta )
and 1 resided at ~ However I have changed my domicjle ~
(Street and Number)
to and am and have been a bona fide resident of the State of Florida sinc.e day of
- d~ , 191a~, and I reside at //SO7 l•r~~ `-P
(Street and Number)
FORT PIERCE, SAINT LUCIE GOUNTY, RORIDA
and this statement is to be taken as my declarat:on of citizenship, actual legal residence and domicile in the State of Ho~ida.
(Insert here any pertinent fads, svch as sale of property or business, or relinquishme~t of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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FILEO ANo- RECOROED ` t
ST. LUCI~ COUNTF ~F~~A•
~F ~~F~ v`F. 18`7055 ~
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~ '69 DEC i S PM 2: 24
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~ F.O~ ER r 017Rt?S
€ • . ~~ERK C1EtCU1T COURT~
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~ I FURTHER GERTIFY that 1 will comply with al) other requirements of a legal ~esident of this State.
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~ I FURTHER CERTIFY that I have no intention to retum to my former domiG~e, and I intend to remain in FORT ?
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~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. - ~
~ F~-w+a M~~[irsv ~o~~l~
~ - - - - - ~ - - _7
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~ (Name)
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~ (Address)
i' Sv~rOrn~to and s4~ibed before me this l~~ day of ~Geu~-~t~ , 19~1
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?a: ~CW~ ~ ~i~A7.. ~ ,
~ ~ " ' ~K CIRCUI~T CQtiRT Notary Public
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~ By . O.C. My Commission expires
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~ (To b~ executed in dupliuh and ori~inal fil~d wHh CIKIc Grcuit Cour~, and duplicst~ with Tax A~stor.)
~ a~Ki81 ~197.7
~ No. 13 ~
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