HomeMy WebLinkAbout0177 DeClaration ot DomiCile and- Citise~shlp
TO THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FLORIDA: °
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This ~s my declaration of Domicile and Citizenship in the State of Florida that 1 em fili~g ihis day in acco~dance and !
~n conformity with Chapte? 22~, Secrio~ 222.17, Flo~ida Statutes.
I was formerly a iegal resident of _ Port Elizabeth _ __New _Jere~_
(C~h•) (State)
and 1 resided at _ DOU~ht~1 ~iBnB ~ _ HQwever 1 have changed my ctomiGile
(Street and Number) F
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ro and am and have been a bona fide resident of the State of Florida si~ce _ 15~h___ _ _ day of ,
Se~tembe]C , 19_?~ , and I reside at _341 JOhxtstou Aoe. , white C1t~?~
(Street and Number)
FORT PIERCE, SAtNT LUCIE COUPlTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal 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.)
CHESTER C.-~HAMBERS JR. lU years ot age.
WILI,IAId T. CHAI~BERS 8 years of age.
CAROL CHAIiBERS ? yeare of age.
JUDITH CO% 6 years of age.
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~ CHILDREN IN SCHOOL
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~ I FURTHER CHtTIFY that I will mmply with aH other requiremenfs of a le~al resident of this State.
I FURTHER CERTIFY that I heve no intention to return to my former domitile, and I intend to remain in FORT
PIERCE, SAINT LUCtE COUNTY, FLORIDA, perma~entfy. ~Q
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~ `FILEO~ANO RECQltO C~ _CHESTER C. CHAI~B~RS SR. t
8T, LUCIE COUNTY. ~ (Name)
~~g p~O IFtEO
341 John~ton Ave., ~
~ - 't0 SEP 16 AM 8 : 20 - - ~
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y. ~ j % , ~ pi 7 ;
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~ • ~ = ROGER 'OI AS 16th SOptember 70 `
• •ti ~_~~d t~
~rV~ ~u~t[R~KIQ~~Ut'~ day of - , 19
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lii• ~r`~A~~1"~1l~~~s - _
•;~C ,C(~CIlIT COURT Notery Public
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By T D.C. My Commission expires
Re b~ ~x~cuNd in dupliuN and ori~inal Bbd.~ Cl~c Circuif Courf, and d+~pliuh with Tax Ass~swr.)
„ eooK 187 PacE 1~
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