HomeMy WebLinkAbout0871 Declaratio~ ot Domicile a~d Citise~ship 1S~`~'~l
TO THE STATE AND ~OUNTY TAX ASSESSOR,
ST. LUCIE COUNTY, FLORIOA: '
Thi: is my declaration of Oon+icile s~d Citizenship in the State of Florida that 1 am tilinq thi: day in acoord~na end
;n conformity with Chapter 222, Sattion 222.17, Flotida Statutes.
I was formerly a legal resident of ~~d~ille pa•
~ (Giy) (Staro)
Rt . xiX 4` . Howevsr I have chs m domidle
and I resided at _ t y
(Street and Numbar)
to and am and have been a bona fide ~esident of ths State of Florida sir~oe 30th _ day of
„j~~ , 19~l4.., a~d I r~ide at 2b10 North Av -
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this ttatement is to be taken as my deciaratan of citizenship, actual legal residence and domkile in ths State of Horida.
- pnsert here any pertinent facts, such as sale of properiy or business, or relinquishment of employment
at former domidle, removal of family b new domiale, purchase of twme, etc.)
Hoveatcad -
FILED AND RECOROED
Si. LUCIE COUNTY. FLA.
;.~:r(~ :r, +,c.R!Ft~D
' 188~21
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CLERK CIRCUiT COURT ~
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1 FURTHER CfRTiFY that I will oomply with all othsr roquiramsnts of a leflal ~~ideM of thk Stste.
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I fURTHER CERTIFY that i have no intention t~o retum to my former domicjle, and 1 in to remain in FORT
PIERCE, SAINT IUCIE COUNIY, FLORIDA, permanently. ' r' e%`~ .
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~ ` ~ 2619 Nosth A~e., Pt. pierce, F1.
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~ .--'3worn to an~! ~u~scribed before me thi: 16th day of anuar , 19 .
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w % ~ _COURT Notary Publk
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~ gy - ~.C. My Commission expires
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; Ro b~ ~x~cut~d in dupliub and ori ~nnaRl ~i{~d wkb q~~lc Ciraii~ Court, ~ad dupil~at~ witb Tax Aswssora
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