HomeMy WebLinkAbout2045 Deci~ration of Domicile and Citizenship ~ c~~ °
TO THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, F:ORIDA:
T^ - - ~^-f ! n_ :_:e_ ~ f':~: n...4.:.. ~1~ C~~~n ..F LI_.:r#~ fha~ }>r.e f:lir,rs t11:s rla~: in ?t.^rnr~~nri_+ an~{ _
~.~i:a ~a ~.~.u:u w~. ~v~`1~i1c u~i~ w....a~....~...r. t.' . . . . _ _ '
~n conformity wirh Chapter 222, Sedion 222.17, Florida Statutes.
I was formerly a legal resident of Ti1m@at~8___ ~@W_ YOr~L---.
(City) (State)
and ! resided at . 1430 N• 219 _ However 1 have changed my domiGie
(St~eet and Ptumber)
ro and am and have been a bona fide resident of the State of Flo[ida since 9 t$ _ day of ~
;
t
Qctober , 1970 .~„d ~ r~side at ?38 ~old_ Ave. P.O.Boa 1731_ `
(Street and Number)
FORT PfERCE, SAINT LUCIE COUNTY, FLORIDA
and this staternent is to be taken as my declaration of citizenship, actuat 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.)
Establishing residence and entering children in school ~
~
~ FIIED ~AND RECORDEDl
ST. LUClE COUNTY. FLA:"
R~COR^ V~r~IF!~0
1~~5 .
'10 OCT ! 5 PM 12 : 3~
f~'~'~v~~
, :tU:;E:r~ FOITPAS
~ CLERK CIRCUIT GOURT` ~
;
I ;
~ i
~ I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this Siate.
~
~ I fURTHER CERTIFY that I have no intention to return to my former domiule, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~ 111~ti~~1.71ti. ' .
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~ ; . ~ •G (Name)
~
~ 'f':. `'U
~~a Blaine I~H~H ASrIBY
g~ _ ~~~-w #r• ..,J
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f~y.~>~y~~"~:
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_ ~ i~'`'~~.~` ~ Q ~ (Address) ;
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~ ~•(',~',,;:~~'•!~1`~•f i
~ ~ r`~ ~ 15th October 70
~ ':~'t&yv,oK~lp•.~t~d subscribed before me this day of _ , 19 ~
~ ~
~
~ ROGER POITRAS _
~ Q~RK CIRCUIT COURT Notary Public
~ By ~ ~ `J D.C. My Commission expires ~
~ ~ ~
~ _
~ (To be execut~d in duplicate and original filsd with Cl~rk Circuit Couvt, and duplicats with Tax Ass~ssor.)
~ Po~i87 ~2045 ~
No. 13 - - ' ' • - - -
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