HomeMy WebLinkAbout0769 18834i
Dectar~tlo~ ot Domicile and Cltizenshfp
TO THE STATE AND GOUNTY TAX ASSESSOR, ~
~
S1. LUCIE COUNTY, FIORIDA: j
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in acaordanos and
in oo~formity with Chapter 222, Section 222.17, Florida Statutet.
I was forme~ly a legal resident of North Haaptoa Mtdi. ~
(City) (Stata)
and 1 resided at _ 83 Ridp,ewOOd T!!r~ . Howevef 1 have changed my domicile
(Street and Number)
to and am a~d hsva been a bona fide resident of the State of Florida sinoe ~th day of
October , 19 69, a~ i r~ide at 6~6 Yerr Street,
(Street and Number)
FORT MERCE, SAINT LUCtE COUNTY, RORIDA
and this statement is to be taken as my declarotion of citize~ship, actual legal residenoe and domicile in the State of Horida.
(Insert here a~y pe~tinent facts, such as sale of property or business, or relinquishme~t cf emptoyment i
at former domicile, removal of family to new domicile, purchase of home, etc.) s
i
i
HoOeste4d
RECORDEO
FtLED AN COUNTY. FLA•
s-f, I,.UCIE~~ VFR!FtiEU i
CO }
' i
~8834~ 3 : 13 :
~
J~N ~ P~ ~ F
lZQ~:~~r. =01TR S ;
CLERK ~`~CU1T COURT
~ RIRTHER ~ERTIFY that 1 wil) oomply with al) other raquiremenfs of a le~al resident of this Siste. ~
- I FURTHER GERTIFY that 1 have no intention ta retum to my former domicile, end I intend to remain in-FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
MR. CHARLBS B. BBRUBB s
(Nama) i
ti
i
646 Yerr St. ~ At. Pierce, Pla.
f..: °fl~ ;
(Address)
~ ~ ~ - ~ -
- Swd~tt ~~d subsuibed before me this - 14th day of - Tanus~y ' ~q~Q,
, = 1 '•I~ -I
~ ~ ~`L•+~~' a
~r~~V~
Notary Public
.
BY D.C. My tommission expires
Re b~ ~x~arbd in dupticab and ori~inal fit~d wi~h Cl~ic qrwit Cour+, ~nd dupliWN wh6 Tax At~ora
r+o, ~a BOOK~~7~ PAGE ~l6 t.
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