HomeMy WebLinkAbout0169 Declaration ot Oomicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, i
Sl. IUCIE COUNTY, FIORIDA:
1
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.
Cleveland Ohio
I was formerly a legal resident of - - - - -
(Ciry) (State) }
and 1 resided at 4238 w _62t1d StZ@et However 1 have changed my domitile
(Street and Numbe~)
to and am and have been a bona fide resident of the State of Florida since ..17tb-_ day of
~v , ~9~~
, a~~ icSiu@ ai c~r 1
^ (Street and Number) ;
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
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 fads, such as sale of property or business, or relinquishment of employment
' at former domicile, removal of family to new domicile, purchase of home, ett.)
Establishing residence and applying for homestead
,
FIlEO AND RECORDED'
ST. LUCI~ COU~JTY, FLA.
,:rn~.;n ~rG'~'~-•t-~
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'70 J~t~ 5 P~~ I: 26 `
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CU.T COURT
I FURTHER CERTIFY that I 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 domiule, and I intend to remain in FORT ;
's
PIERC~;_ SAINT LUCIE~.COUNTY, FLORIDA, permanently. f
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- ' . . - (Name) ;
' " ;
, James R. Leathers ~
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~ , - . :
~ ~ . _ - ' (Address) ~
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Swom to and subscribed before me this Sth day of January ~ 19 70 ;
~
ROGER POITRAS
K CIRCUIT COURT Notary Public
~ g ~~-~-L-E-- D.C. ' My Commission expires
Y
(To be executed in dupliute and ori~inal filed with Clerk Circuit Court, and duplicats with Tax Assessor.)
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~ BOCK. FhGC 16& ~
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