HomeMy WebLinkAbout0784 .
O~cla~atio~ of Domicil• antl Citis~~ship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FIORIDA:
This is my declaration of ~om~cile and Citisenship in the Stete of Florida that I am filin~ this day in acoo~da~oe and
~n conformity with Chapter 222, Settion ~22.17, Florida Ststutes.
I was formerly a ieya~ res~denr of .-~igh~~~~erson Air Force Base D~yton, Ohi4
(City) (Stah)
453 E Street ( Base)
and 1 resided at However 1 havechan~ad my domidle
(St~eet ~nd Number) ~
to and am and have been a bona fide ~esident of the State of Florida since day of
_._Oc_taber , i9__~Ahd I res~de ai _l`~5 Sunshine A~e. Port St. Zucie
(Street and Number)
fORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaratio~ of citizenship, actual legal residence and domicile in tha State of Norida.
" (Insert here any pertineM fads, such as sale of property or busineu, or relinquishme~t of employment
at former domicile, removal of family to new domicile, purthase of homes, etc.)
Establishing r e~idence and applying for homestead
. 2G2848
UCIE COUNIY fL~.
~OCER POITRAS
- ~LERK CIRCUIT COURt
RECORD VERIFIEO~,~
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€ I FURTHER CERTIFY ihat I will comply with all other requirementt of a leqal resident of this Stste.
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~ 1 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 WCIE COUNTY, FLORIDA, permanently.
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~ ~ ~~t. O~'Q,~~"% (Name)
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~ ~ ~ • Richard H. Cook
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~ ~~~~~~to,~nt~~subscribed before me this 4th day of January ~ 14 7~
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~ ROGER P~ITRAS
~ CIRC T COURT Notary Public
~ BY ~~L~ D.C. M~ommission ex ires
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~ Ro b~ ~x~nM~d in duplicat~ and «i~inal fil~d wiTh Cl~ric Cirwk Cou~t, and duplicat~ with Tax Ass~s~or.)
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~ ~ ,3 BoaK 189 ~~~E 78z
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