HomeMy WebLinkAbout2168 Form S. T. C~801-D (l~---9~3)
Declarcction of Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Qr . Lnci~ COUNTY, FLORiDA:
This is my declaration of Domicile and Citi~shtp in the State of Florida that i am filing this day in acoord-
an~ and in oonfornaity with Section 222.17, Florida Statutea.
I was formerly a leg,al resideut of Pangaeala ~ Florida
(~Y) (Stabe)
~ I~~ ~ 4811 North 12tb Av~snne Ho~vever, I hav~a changed my domicile
(Stceet and IVnmbar)
to and am and have been a bona ~ide residant af the State of Florida sinoe .dn~ ~ ~ ~?Y °f
198_? , and I reside at .
(Straet and Nombec)
W1IN NAVY BUILDING, IU~HIN(~ON~ D. C. ~ ~~~~da,
(c~?)
and this statement is to be take~ as my declaration of c:itizenship, actual legal reside~oe and domic~le in the State
of- ~'lorid~a. - _ _ - - - _ _ _ _ _ - _ _ - - _ _
(Insa~t here any pe~tlnent fads. wch as sab of~pmp~ty ar basiue~s. or sdin4uiahment of anpbyment at
focmer domk~la r~w~?d of famity to navr domicile. Wrc~ase of Lome, eoa)
I aa a~eaber oi the D.S. 1[ilituy Foraes, have pnrehased P='aPBr~F in Port
St. Lucie, For~ Pieree, Florida, and intend to bnild s haee and sake this
~ ~qr pQ~sanent residenee. ~
FI~ED AND RECOftDEO' .
ST. LUCIE COUNTY. FLA.
R= CQRQ VERIFIED
19153
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_ ~~~G tA
ROGER TRAS
CLERK CiRC T COURT;
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I FURTHER CERTIFY that I will register at my local address wl~en the registration books reopen, and
comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and i intend to remain in
Fort Pi e rY , 3t . LnC i e , Ca~nty, ~'lorida,
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~N'm°~ . 8. Basaing, Capt.
~ II. 3. N.
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~ ~{~f ~ - (Address)
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' wp~ ~pcibed before me this ~q day of
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~ 'C 1 - A. .19J'i11-.
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~'~i,;~~~ fi: S ~ p~~ e:ecuted 'm dupUcate origlnd filed with C1erk Circuit Cou~t. and duplicate v.itL T~ Asses~or)
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