HomeMy WebLinkAbout0841 Declaration ot Domicile a~d Citizenship
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TO THE STATE ANU COUNTY TAX ASSESSOR, ~
Sl. LUCIE COUNTY, FIORIDA: ~
Thi is m declaration of Oomicile and Citizenshi in the State of Florida that 1 am filing this day in actordance and ~
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~n conformity with Chapter ??2, Section 222.17, Florida Statutes. ~
Xenia ~ Ohio
1 was formerly a legal resident of . _ _ _ _ _ - - - - - -
~~~ty~ (State)
and I resided at Rt 6 . However 1 have changed my domicjle
(Street and Number)
to and am and have been a bo~a fide resident of the State of Florida since 23rd _ _ day of _
September ,~v70 , and I reside a~ 228 West Camino St. _
(Street and Number)
FORT PIERCE, SAINT IUCIE COUNTY, FLORIDA
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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 ot property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, p~rchase of hom~, etc.)
~ntering DouglPS in the 4th grade
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~ Wickman ) r
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~ FIlEO'AND'RECORDEO~ '
ST. LUCtE COUNTY. FLA. ~ i
IiF:GARR VERlF1~0- - -
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'TO SEP 2q PM 3~
ROGER PQITRAS
CLERK CIRCUIT COURT~
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I FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State. ~
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I FURTHER CERTIFY that 1 have no intention to return to my former domic,ile, and I intend to remain in FORT ~
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PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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. , _ ~ ~ (Name)
~ _ ~'y~~j : Charlea Beason
' L~ _ .;',id.-1• r~: ` _ - -
~ - - ~ - _ ~ ~ + (Address)
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~ " 24th Se te~ber 70
~Svit~tH'tb~and subscribed before me this _ day of _._-_-.__p___.____ 19
~ ROGER POITRAS
~ K CIRCUIT~OURT Notary Public
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By a-r L~ ~.C. My Commission expires
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(To b~ ~zecut~d in dupliut~ snd ori~i~al ~ilsd wiTh Cl~rlc Circuit Court, and dupliut~ with T~x Ass~ssor.)
„ aooK 187 ~~E 841
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