HomeMy WebLinkAbout2971 Declaration ot Domicile and Citizenship
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TO THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FIORIDA: ~
This is my declaration of Domicile and Citi=enship in the State of Florida that 1 am filing this day in aooordance and
in tonformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of Jeffersonville I11d.
(City) (Stats)
and 1 resided at _~02 '~h8me8 D2'. . However I have changed my domiCile
(St~eet and Number) ,
to and am and have been a bona fide resident of the State of Florida since _ 14th day of
_February ,~q~, and i reside at 1606B Jersey Ave.
(Street and Number)
FORT PlERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual tegal residence and domicile in the State of Florida.
(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.) .
(TsLwbli.eh Reaideney)
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FILEO AND RECOR EO ~
ST. LUCIE COUNTI~.~LA. ~
~~~.C~R~ VE~;FIF`D ~
19420'7
' '10 J!!~; 5 AM 9: 2 8 • ~
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C~~'RK ClRCUIT COURT
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~ I FURTHER CHtTIFY that 1 will oomply witfi all other requirements of a leyal resident of this State.
1 FURTHER CERTIFY that I have no intention to retum to my former domiGle, and 1 intend to remain in FORT
~ PlERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. Epg StOri@ ~MZ's. Leroy H. ~
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~ (Name) .
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~ 1606B Jersey Ave.
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(Address)
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~ Sworn to and suburibed before me this 5th day of `j~e , 19 7~.
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~ ROGER POITR/1S J,: T ~U .
RCUIT CO ' Gv~ ~ Notary Publtc
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~ By ~ ` ~ - - - ~ A.C My Commission expires
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~ (To b~ ~x~cut~d in dd ~iq~ .iil~d with Urwk nd duplicat~ witb Tax Ass~ssor.)
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~ s'!~.~~; 0 R 104 PAGE2~~
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