HomeMy WebLinkAbout1561 Deciaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
51. IUCIE COUNTY, F~oR~oA: 219580
Th~s ~s my declaration of Oomicile and Citizenship in the State of Floricia that 1 am fifing this day i~ accorda~ce and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of ROCheeter 1[Pw Ynrk _
(Ciy) (State)
and I resided at 66 FOrea~m ROa d__ _ However 1 have changed my domiCile
(Street and Number)
fo and am and have been a bona fide resident of the State of Florida since __~__24th day of
_ November 19 ?1, and 1 reside at 2725 So 25th ~etreet
(Street and Number) ~
FORT PIERCE, SAIN? LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, aztual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, r~r±^~~! ~f fy~~l~ new domicile, purchase ot home, etc.)
Eatablishing resicence
fILEO A!1p RECQRQEB
tt. LUC1E COYMTr FU.
` iIOCEF POITRAS
' CtERK CIRCUIT COUAT C
i REC4A0 yER~F~Ep~~
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_ ~bY 19 1~ 38 AM'1 ~
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~ 219580
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I FURTHER CERTIFY that I will tomply with all other requirements of a legai resident of this State.
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; I FURTHER CERTIFY that I have ~o intention to retum to my fnrmer domiti~e, and I intend to remain in FORT
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PIERCE,~SAINT,:LI~ZIE COUNTY, FIORIDA, pe~manently.
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. ~ (Name)
~ - ;.r*',~~""t'"~:,'~~-. _ Ed . Tolhurst
_ - G.~,O'_
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Ln• ~ ~~;Q_ -~/Lain,~',~~ ~
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_ E a Frances Tolhur~t
- c1 29th lfovember
,'.~Sworn to and subscribed before me this day of . 19~-•
R GER POITRAS
C RK CIRCUIT OURT Notary Public
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~~,f~c~ ~'z ~t ~ 1
ey D.C. My Comr~j~~ion expires (
_y
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(To be exewted in duplicate and original filed with Clerk Circuit Court, and duplicate with Tax Assessor.)
so~x 197 PACE1559