HomeMy WebLinkAbout0163 Declaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, ~
51. LUCIE COUNTY, FLORIUA:
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This is my declaration of Domicile rnd Citizenship in the State of Florida that I am filing this day in actordante and }
in conformity with Chapter 222, Section 222.17, Florida Statutes. ~
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1 was formerly a legal resident of ___HO~.ewell N• .l• _ $
(Ciy) (State)
~7f 118 T~ylO! Terrace However 1 have chan ed m domicjle '
and I resided at 9 Y ;
(STreet and Number)
~ to and am and have been a bona fide resident of the State of Florida since AV$~1_____- day of
601 So 17th Street
_ _ _ _ . , 19
~4, and I reside at - -
fORT PIERCE, SAINT LUCIE COUNTY, FIORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent fatts, such as sale of property or business, or relinquishment of empioyment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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~(~~r~~~~ c~~z~ <-l~~c FILEO AND RECORDED
~ ~ ST. LUCIE COUNTY, fLA.
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..1~~S~j~~j'~~)
- '70 ~at~ s P~t ~2:2s
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I 1j / 7
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~ CLERK C~RCtiIT COUr~T ~
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1 FURTHER CERTIFY that 1 will comply with all other requi~ements of a lega) resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to ~emain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ ~ (Name) Je nne M. Johnson
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~ . ~ . (Address)
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~ - ~ Sth January 70
' Sworn to ~end subscribed before me this day of , 19
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Ps . ' 2
~ ~ RGGER PO~TRAS
~ ~ ClRCUIT COURT Notary Public
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~ gy ~ D.C. My Commission expires
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~ (To bs exxuted in duplicate and originsl ~iied with Clerk Grcuit Court, snd dupliuts with Tax Ass~ssor.)
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s~RK 1~2 ~?~f 162
1vo. 13
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