HomeMy WebLinkAbout1968 Oeciaratio~ ot Domicil~ and Citisanship
TO THE STATE AND ~OUNTY TAX ASSESSOR, ~Clb''7''?
Sl. WCIE COUNTY, FIORIDA:
~ This is my decla~ation of Domicile and Citizsnship in the State of Florida that 1 am filin~ this day in aooordanos and
in conformity with Chapte~ 222, Section 222.17, Florida Statutas. .
1 was formerly a legal resident of ~~J . -
(Ciy) ~ (State)
and I residad at Z~~i~fl'on ~t /1dI1C - _ However 1 have changed my domic~le
~ ~ (Sheet and Number)
to and am and have been a bona fide resident of the State of Florida since day of
~'~i ~b C/1t I' .~O ~h • ~ . .
- , 19~, and I reside at _ - _
(Street and Number)
FORT MERCE, SAINT ~UCIE COUNTY, RORIDA
and this statement is to be taken as my deciaration of citizenship, actual legal reside~te and domicile in the State of Florida.
(Insert he~e any pertinent facts, such as sale of property or busineu, or relinquishment of employment _
.
at former domicile, removal of family to new domicile, purchase of home, etc.)
Establishing residency -
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~ j 3 ~t ~M'11
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I R1R7'HER ~ERTIFY that I will oomply with all other requirements of .a le~sl resldent of this Stete.
1 FURTHER CERTIFY that 1 have no intention to retum to my former domiule, and I intend to remain in FORT
PIERCE; SAINT LUCIE COUNTY, FLORIDA, permanently. ~ -
G.
pr~~ ~•"'~aw8an
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, ~,f`'~~, i~~ -.-~••:,~~+bs~tibed before me this day of , 19~-
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~y ' . D.C. My Commission expires
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(To b~ ~x~wNd in duplicab and o~inal fiNd wNb CtKlc Wwrif Co~rrf, and dupNsah witb Tau As~o~a
fo~C~88 ~1~i5
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