HomeMy WebLinkAbout1378 De~laratio~ ot Domicile a~d Citise~ship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E ~OUNTY, FIORI~A:
This is my decla~ation of Domicile and Citizenship in the State of Flo~ida thet 1 am filing this day in accorda~ce and
~n co~fo~mity with Chapter 22?, Section 222.17, Flo~ida Statutes.
I was formerly a legal resident of Renere _R__. YasB.
(City) (State)
and 1 resided at 37 B1Ckf02'd AvB. . However I have changet! my domiCile
(Street and Number) ~ ~
to and am and have bee~ a bona fide resident of the State of Florida since -17~h.. day of
September ~~0 , and i ~es~de at _ 106 Eldea 3t. Port St. Lucie
(Street and Number)
FORT r1ERCE, SAINT LUCIE COUNTY, RORIDA
and this stateme~t is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment ~
at former domicile, removal of family to new domicile, purchase of home, etc.)
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Tsetablishing residence =T~E
CIE C~uN~ f~
~40EIt POiTRAf
CLERK CIRCUIT COtIItT
RECORO YERIFtEp.~.~...
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I FURTHER CEltTIFY that I will comply with all other requiremenri of a leyal resident of this State.
I FURTHER CfRTIFY that I have no intention to retum to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE_~t1NTY, FLORIDA, permanently.
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= `:r ~ ~ • s ldra Thelma P. Campbell -
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Sworrt~~d~i!?~~ut~ascribed before me this _ 23rd day of 8ovember ~ ~q 70
ROGER rO1TRAS
CIRCUR COURT Notary Public
- gy D.C. My Commission expires
(To b~ ~x~cuMd in dupliub and ori~inal fil~d with Cl~rk Circuif Courf, ~nd duplicah with Tax AsWStos.)
doo~188 ~1375
No. 11
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