HomeMy WebLinkAbout1976 De~laration o~ Dor~nt~iie and Citize~shlp 213'713
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. WCIE COUNTY, FIORIDA:
This ~s my declaration of Dom~ule and Gtizenship ~n the Sta~e of Flo~ida that I am filing this day m accorclance and
~n conformity with Chapter ?22, ~ection ??2.17, Florida Statutes.
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I was formerly a legal residenl of _ _ _c2 c__
(City) (State)
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and 1 resided at i/VI. / _ _ Nowever I have changed my domicile
(Street and Number)
ro and sm and have been a bona fide resident of the State of Florida since ~y day of
/I L . 19_ , and I reside at ~ J~ f~UL~ . ~J.
(Street and Num r)
FQRT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal resider.ce and dom~cile in the State of Florida. ~
(Insert here a:~y pertinent facts, such as sale of property or bus~ness, or relinquishment of employment
at former domicile, ~emoval of family to new domicile, purchase of home, etc.)
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~ fIlEO ANC RECORGEO
j ST. IUC~E COUMTY FU.
ROCER ?01TRAS ~
~ CLERK CfRCU1T COUIIT P ~
I RECOAO YEa~fIEO~..~---
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1 FURTHER CERTIFY that I will comply with all other requireme~is of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domiule, and 1 intend +o remain in FORT
PIERCE, SAiNT LUCIE COUNTY, FLORIDA, permanently.
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(Name Lilly ~f . Green
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~ (Address)
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~ Swom to and subscnbed before me this ~
2t~ day of _ Au.~u8L_ ~q ~]1
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' ROGER POITRAS - '
~ C K CIRCWT COURT Notary Public
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~ By D.C. My Commission expires
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~ (To be exacut~d iw. iWpfi~(~:ini o?i~insl fited with Cleric Grcuit Court, snd duplicats with Tax As:essor.)
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