HomeMy WebLinkAbout0075 ~
peclaratl4n ot~ Domicile and Citizenship ~
TO TNE STATE ANU COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FIORIDA:
This is my decleretion of Domiule and Citizenship in the State of Flo~ida that I em filing this day in eccordance and
~n conformity with Chapter ?22, Section 222.17, Floridd Stetutes.
I was formerly a legel res~de~t of _ _H8?21ehut8t G60I`gi8__ _
(City) (State)
;
end I resided at . G@riBY'81 D@11V6Z'3/ . However I have changed my domic.ile
(Street a~d Numbe~)
to and am and have been a bona fide resident of the State of Florida since • _ __31 _ _ day of
_ OCtobe2• , 19_?~ , a~d I reside at Rt. 1_ _ BloomfiRld Rd. ~
' (Street and Numbe~) ~
FORT PIERCE, SAINT LUCIE COUNLY, RORIDA ~
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and this statement is to be taken as my declaration of citizenship, actual lega) residence and domicile in the Stete of Flo~ida. ;
(Insert here any pertinent facts, such as sele of property or business, or relinquishment of employment ~
at former domicile, removal of family to new domicile, purchase of home, etc.) ~
(School Children)
Wanda Fay - - ?th Grade
_ Joe Lonzie - 7th Grade ~M2004 9_ . -
~``~ER~~~
Chester Rishard - 4th Gracie ~~RD v[Rij~p~~
' ~ 3 g s~ ~N'TO
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1 RIRTHER CERTIFY that I will comply with all other requirementa of a leys) resident of this State. ;
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I FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT ~
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PiERCE, SAINT LUCIE COUNTY, FLORIDA, permanently_ ~lOZ`eri@ TOler (Mrs. James L. ) ~
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~ . x~o-2 c~-c, ~'~-t~ _ ~
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~ (Name)
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Sworn to and subscribed before me this 3rd day of November ~q 70 ,
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ROGER POITRAS ~ . . . '~'~i
YJ . ~
CIltCtH~~C 1 ••••.`j'r Notary Public
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BY " D.C. My Commission expires
:~•c~ -iu= .
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~ Ro b~ ~x~ui?r~;li;tl~lita~l. wi~inal fil~d wilh Cl~lc Cirarit Court, and duplitat~ whh Tax Ass~swr.)
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5~ • aooK 188 PACE 75 ~
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