HomeMy WebLinkAbout1371 Oeciaratio~ ot Domicii• a~d Citizenship 2Q1341
TO THE STATE AN~ COUNTY TAX ASSESSOR,
i
Sl. WCIE COUNTY. FIORIDA: !
i
This is my declaratio~ of Domicile and Gitizenship in the State of Florida that I am filing this day in acco~dencs and ~
~n cw~formity with thapter 222, Section 222.17, Florida Stat~tes.
1 was formerly a legal resident of DB~ytOY1 _ Ohf O _
' (Ciy) • (State)
' ~ i
and I ~es~ded ar _.___~_?3?__ Perrine $t. However 1 have chsnged my domiCile
(Street and Number)
ro and am and have been a bona fide resident of the State of Florida since 16th day of
_-____BDV~m~~__-_, 19~~ , and I reside at 511 A S. 31st St.
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statemenY 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 propery or business, or relinquishment of employment
at former domicite, removat of family to new domicile, purchase of home, etc.)
(School Childr-zn)
Annette Jean - 2nd Grade
Pamela Fay - lat Grade ~~E COEG Y~
110CER P01?RI?=
RE11~Itp YER iC1E0 C...~~'~`
No~ 23 l0 4s AN'i1
~
~ - 20134i
~
~
~ -
~ I RJRTHER CERTIFY that I will oomply with all other requirements of a leya) resident of this State.
1 FURTHER CERTIFY that f have no inte~tion to retum to my former domicjle, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. 1ZZZ W11ID8 Brown
.,,~'I`.~~~ ~ ~ ~ti1-L >
(Name)
~
~
~ (Address)
Swo~n to and wbscribed before me this 23rd day of November ~ ~q 70.
~
,
a `>>~~W~u/i.H;;a~ .
R ~ •
• ~ ~~j~
, ! % Notary Public
. •
.
By ~ D.~. My Commission expires
. ~ = ;a I~:•~~ =
...FA ~ ~ ~7 i7i~ ~ 7 ~ • (y :
.~i •
i ~ 'R' • 1
lY~ ~i F' ~i~ and oripinal fil~d with Cl~rk Cirwh Cour~, and duplicat~ with Tax Ass~ssor.)
: ~~,;=,a.~,s.t,;;,:,~~~ ~ ~ 188 PACE136~3
600K
,to. 13 `
~~i ~ , - - - - - •n~.r t_: -
a