HomeMy WebLinkAbout1050 !
1885'7~
Declaratior~ ot Domicile and Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FtORIDA:
This is my ueclaration of Domicile and Citizenship in the State of Florida that ! am filing this day in acaordanoe and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resiclent of _ st• Clt~t $~10tls ~Ch~
(City) (State)
and 1 resided at ~_.~9a0 Ali[!~t $t. However I have changed my domic~le
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since aZod day of
tOber , 19 69, and I reside at 110 W. Caali~0
(Street and Number) ~
;
1
fORT PIERCE, SAINT LUCIE COUNTY, RORIDA ~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida. ~
(Insert 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.)
H~oaestead
~ ~ ;
RECORDED' `
- - FIl.EO AND ~UNTY.
ST~ ~E.CO n ~~ERIFIEO
1.8a5~~ ~ ~ : 55 ~
'TO JAN 2~ ~ r~
~
~:o~~~ rot~r ~ouRS:.
~ CL~RyC CIRCUIT
I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State. E
~
I FURTHER CERTIFY that I have no intention to return to my former domicjle, and 1 intered to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~
GBQRGB B. CHHRtiIA[ .
(Name)
. _ 110 M. Caaino
:i:i:a'~~~ (Address)
: ~ ' ~',?`1f, - -
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; s ,sr ..y
- _
'~yS~rpt~~~aqd>sdbscribed before me this 20tb day of Tanuazy ,~q 70.
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- ~9~e~~ ~ ':ClRGtl~3 COURT Notary Public
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By k _ D.C. My Commission expires
, _ j:.
Ro ex~cuted in dupliute and ori~inal fil~d with CIKk Circvit Court, and dupliu» wiM~ Tax A~ssor.)
~ goaK 182 ~~E 1048
~ No. 1 ~ _
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