HomeMy WebLinkAbout0790 1883~~~.
Declaration ot Domicile and Citizenship
,
TO THE STATE AND COUNTY TAX ASSESSOR,
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Sl. lUC1E ~OUNTY, FLORIDA: {
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This is my declaratio~ of Domicile and Citi=enship in the State of Florida that 1 am fil~~~ lhis day in acodrdanos and ~
in conformity with Chapter 222, Section 222.17, Fiorida Statutes. ~
1 was formerly a legal resident of Stoneq Point IdQM YOr~
(City) (StaM)
and I resided at 90 S~ji~ii~r Basio ~ However I have changed my domic~le
(Street and Number)
to and am a~d have been a bona fide resident of the State of Florida since 1Sth day of
October , 19 69 , and i ~es~de at 1002 Hiapana A~e.
(Street and Number)
F4RT r1ERCE, SAINT LUCIE COUNT1f, FLORtDA
a?~d this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
pnsert 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.)
~
Homeatead
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FILED AND RECOROED' `
, 5T. LUCIE COUNTY, FLA.
f?=_rflr(` t~cr~Fi~Q
~ 188364
'70 JA~ r s A~ g: ~ y
~:a:;,?- ~-o,
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CLERK C{RCUIT COURT
1 FURTHER CEitTIFY that I will oomply with all other requi~ements of a le~al residem of fhis State.
t FURTHER CERTIFY that f have no intention to retum to my former domicile, and I intend to remain in FORT ~
i PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~m ~
~ ~
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HitI7CS 1~1. PROSKB
(Name)
I ' ' ~ • • .1 .
~
. ~-~;•r.~~ - 1002 Hiapana A~e.
" I~ ~ " Ulddress)
, . :
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- •
' . ~Swom to and.~kiscribed before me this - 1s day of _ January 19~Q
- •;v . ~
. • :
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~ ~ Roa~ romws
CIRCU COURT Notary Public
BY ~ D.C. My Commission expires
.
(To b~ ~x~cuhd ln duptiut~ aed ori~ina~fi~d~~ C{~rlc C~t,~ourf~ snd duplicat~ with Tax Atassor.)
BOOK PACE
lvo. 13 ' - - ~ - -
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