HomeMy WebLinkAbout0179 Declaration ot Domicile and Citizenship F~
TO THE STATE AND COUNTY TAX ASSESSOR,
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Sl. LUCIE COUNTY, FLORIDA:
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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.
I was formerly a legal resident of _ Allerl Park MiChi$8A
- ~City) - - - (State)
8120 KOlb . However 1 have chan ed m domicile `
and 1 resided at - 9 Y
(Street and Number) ~
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to and am and have been a bona fide resident af the State of Florida since 14th____ day of
March 69 1607 Seativay Dri~e
19-__, and I resid~ at
(Sfreet an um r
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, adual legal residence and domicile in the State of Florida.
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(Inse~t here any pertinent facts, such as sale of properry or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchas~ of home, etc.)
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Bstqblish Residency (Homestead)
FILED AP~D RECORDED
ST. I.UCtE COUNTY, FLA.
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~ 'TO J~~~~I S PM 2: 24
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CLERK Cif2CllIT COURT
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I RIRTHER CERTIFY that I will comply with all other requirements of a legal resident of this State. ~
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I FURTHER CERTIFY that 1 have no intention to return to my former domicjle, and I intend to remain in FORT ~
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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~ (Name) Nelson C. H rq
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~ ' 10~// Je~NaY L)r1~C~ t'~• riCiVC~['ii4~ ~
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~ =.Sworn to and subscribed before me this $th day of January ~ 19 70
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ROGER POIYRAS i
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; C CIRCUIT C T Notary Public
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~ By D.C. My Commission expires
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(To be executed in dupliute snd original filed with Clerk Grcuit Cour1, and duplicst~ witb Tax Assessor.)
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~0 13 800K
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