HomeMy WebLinkAbout1918 ~
Declaratlon ot Domtcfl• and ~Citts~nshlp
TO THE STATE AN~ COUNTY TAX ASSESSOR. 2C 1642
51. IUCIE COUNTY. FLORI~A:
This is my declarotion of Domicile and Citize~ship in the State of Florida that 1 am fiti~g this day in aooordanos and
in conformity with Chapter 222, Sectio~ 222.17, Florida Statutes. k~
or~ z e u/ ~ p
I was fo~me~l a I al resident of ~ l ~
Y e9 ~1~
(Ciry) (Stafe) ~
and I resided a~~~11_~~~~t ~"a~ `r~ C~~_-. - M
ow
~~e~'1 have d~anged my domitile
(Sireet and Number) ~
to and am and have been a bona fide resident of the State of Florida si~ce day of
. 19~d , and I reside at~/~~/',~dN'/C~ (L~r~ / a/?~ ~~l~C'/~
~ (Street snd Number)
FORT PIERCE, S~AINT tUCIE COUNTY, RORIDA
and this statement is to be take~ as my declaration of citizenship, actual tegal residence and domicile in the State of Horida.
{Insert he~e any pertinent facts, such as sale of property or business, w reli~uishment of employment
at former domitile, removal of family to new domicile, p~rchase of home, ett.)
Sstablisbiu~p~ Residency ~ @ pp~
~ ~ ~ . YCIE CO~T~ ~ ~
~ER POIT~+?= ~ ~
~~ERK CIRCINT. j~l~+~'~
REC01?o 11ERtftEO .
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2ai642
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I_ RIRTHER CERTIFY that 1 will aomply with all other requirements of a leysl reiident of this Statd.
I FURTHER CERTIFY that I have no intention to retum to my former domicjle, and I intend. to remain in FORT
PIERCE, SAINt LUCIE COUNTY, FLORIDA, permanently.
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` Lecnmrd (Name) j~d,dprno
~ . (Address)
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~ ' ,;?.,..,r~,~::;;ri- lst. D~e~~er . 70
:•~prn- ~sybsuibed before me this day of , 19 .
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p;~~~~a~~~y~~`~'~` ~f. < :
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~ S~, ~ ~ ~ Notary Public
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By, :'.'A ` , ~ D.C. My ~ommiuion expires
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Re b. .oc.w~.d i~ duplk.~. and o.i~~al til~d wilh a..k e~ c.w1, .~d d~lie.~. wi11~ Tau A.....e~a
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