HomeMy WebLinkAbout0093 Declaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida thai"1`artrrfili~g this day in accordence and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of _Campbell _ M8. ;
(City) (State) `
Route 2
and I resided at _ _ _ _ _ - . Howeve~ l have changed my domitite
(Street and Number)
to a~d am and have been a bona fide resident of the State of Florida s~~~e _ December 2 day of
South 25th Street
- a,,,~ ~ r~~~ ~ ABC Trailer Park ~
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual lega! residence and domicile in the State of Florida.
(Inssrt here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
~nterin~ children in public school
Keit!:, Everett Lee, Julie Payne F~LED .;r~u ~ECOitGED
' ~U ~fE ~i;.JUt:''Y F~ ~
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I FURTHER CERTIFY that 1 will comply with all 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 domic.ile, and I intend to remain in FORT ~
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
~ ~
~ - (tvame) Everett Lee Payne
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~
, .
~ (Address)
~ - -
~ _ : 5th January 70
Swo~n to and subscribed before me this day of , 19
~ ' i
~ ROGER POITRAS
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~ K CIRCUIT COURT Notary Public
~ By ~ D.C. My Commission expires
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(To be sxecuted in duplicate and originsl filed with Clerk Grcuit Court, and duplicate with Tsx Ass~sso~.)
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~ ~ R 1~2 ~ ~3 .
r,~. ~ 3 BOOK
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