HomeMy WebLinkAbout1468 DeClaration ot Domicile and Citizenship
2~ 1451
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FLORIDA:
This is my declaration of Domi~i~~ and Cititenship in the State of Florida that 1 am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of Rh121e GeOrg18 ~
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(City) . (State)
and I resided at _ BOX 9'T However I have changed my domicile
(Street and Number)
ro and am and have been a bona fide resident of the State of Florida since 18th _ day of
December ~9_~l, and 1 reside at R~_L ~QXX_ 61~1 Rock Road
(Street and Number)
fORT PIERCE, SAINT LUCIE COUNTY, FLORIDA `
and this statement is to be taken as my declaration of eitizenship, actual legal residence and domiciie in the State of Florida.
(Insert here any pertinent 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.)
2~~451
ri~EO ~r~o aECOapE
ST:lUC1E COUNTY iL~
Eatablishing residence Roc~P PoirR~s • ~I~~__,,,
CIERK CiRCU1T COURT ~ / ~
RECORD VER~FiEO~~...~...
~A1! ~I 9 46 ~N'TZ
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~ 1 fURTHER CERTIFY that t witl comply with all other requiremenis of a legal resident of this State.
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I FURTHER CERTIFY that I have no intention to retum to my former domiule, and 1 intend to remain in FORT ~
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently_ ~
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~v=~ - ~ (Name)
~ - Snrah Grace Ott
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Sworn to and subscribed before me this 4th day of -~Ianuar~ , 19~_. ~
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ROGER POITRAS
- K CIRCUI COURT Notary Public
J~ By G'--~~ D.C. My Commission expires
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(To be executed in duplicate snd ori~insl Rled with Cl~rk Grcuit Court, and dupliut~ with Tax Asssssor.)
s°ooK198 P~~E~4~
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