HomeMy WebLinkAbout2698 Declaratiers ot Domicile and Citizenship
TO THE STATE AND CnUNTY TAX ASSESSOR. ~~419'~
51 WCIE COUNTY, FlORIOA
Th~s ~s my declarat~on of Qomicile and Citizenship ~n the Stare of Flo~ida that I am f~l~ng this day ir. accordance and
n conformity with Chapter ?22, Section 222.17, Florida Statutes.
I was formerly a legal resident of --C..QX.e~ "~V'"~"-~- -
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and I resided at ~Lfa ~~'L4~~ - N~.vever I have changed my domi~,ile
i5treet and Number)
!o and am and have been a bona fide resident of the State of Florida since • ~'ay of
, 19 ~7~ , and I reside at _ l~O cf '
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
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and this staten,ent is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida. `
(Insert here any pert~nent facts, 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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~ILEG A~iC RECO~~
ST. UiCiE C~UNFr 4.
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~ RESIDENCE 21419'7
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1 FURTHER CERTfFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domiGle, and I intend to remain in FORT
PIERCE, SAINT LUC!E COUNTY, FIORIDA, permanently.
FRANK D . CI,A~i SON
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~ (Name)
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y Sworf? io aatl w~scribed be`ore me this - day of _ _ 19 7~.
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~ ~ RGGroR''~~11R~s - - - - - - - - - - -
~ t'{ER~~-CIRQu1T CO T Notary Public
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~ BY _ - -~`'~~'t_-_ _ D.C. My Commission expires
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_ (To be executed in duplicate and original filed with Cleric Grcuit Court, and dup{icate with Tax Assessor.)
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