HomeMy WebLinkAbout1172 Declaration ot Domicile a~d Cttizenshlp
TO THE STATE ANO COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA: `,fjS ~
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
in conformity with Chapter 222, Section 222.17. Florida Statutes.
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I was formerly a legal resident of _~RI,OW HEIGHTS 1Ld.
- - (City) - - - (State)
and 1 res~ded at _ 63.34 Dallai _PZtIC@_ __u However I have changed my domicjle
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since 29th day of
_Dece~ber , 19 71 , and I reside at ~28 W. Prima Vists Bl~d. ,_Pt. _St. '
(Street and Number) I,LiC3g ;
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this stateme~t is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employme~t
at former domicile, removal of family to new domicile, purchase of home, etc.)
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RESIDE*;CE n~Ea~~n R~c~R~~ /
iT.ltIG1E G~WITY~
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C!~^K t ~ ~tiUlt COURT :
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~ I FURTHER CERTIFY that I will comply with all other requirements of a(egal resident of this State.
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; I FURTHER CERTIFY that I have no inteMion to return to my former domicjle, and I intend to remain in FORT
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~ PIERCE, SAINT LUCIE COUNTY, FLORtDA, permanently. ~ C/~'~
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. . NEAI, 0' I,EARY
. _ _ ' - " , - (Name)
~ ~ C„~ \1 ~ J ,.~r
= _ ~ - 128 ~l. Primn Yieta, Bl~d.,
~ "r~ ~ ~ i (Address) POTt St. Lucie
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~ry . - Swor~ to;e~ld subscribed before me this 'S Oth day of _ De c emb er 1 q~_.
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ROGER POITRAS
~ ttERK GRCUIT COURT Notary Pubiic
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8y _ D.C. My Commission expires
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(To be ~xecut~d in dupliut~ and ori~inal filed with CIKk Circuit Courf, and duplicat~ with Tsx Assessor.)
; 3 A 6ooK 198 F~E 1171