HomeMy WebLinkAbout1646 .
~eclaration ot Domicile a~d Citizenshlp %~~15y3
TO THE STATE AND COUNTY TAX ASSESSOR, ~
,
51. LUCIE COUNTY, FLORIDA:
lhis ~s my declaration of Dom~cile and Citizensh~p in the Sta~e of Florida that I am fili~g this day in accordance and
~n conformity with Chapter 222, Settion 222.17, Florida Statutes.
~ ,E : ~~~J ,
1 was formerly a legal resident of ~~~-t'~ f~~"~
(Cify) ate)
and I resided at 7~~ ~ . /r ~J 7. However 1 have changed my domiG~e
(Stre and Number) ~
~o and am ared have bee~ a bona fide resident of the State of Florida since ~ , 7 l-- - day of ~
_ , 19_ , and 1 res+de at ~~~t ~ _ - ~
(St' r t and umb2r)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and th;s slatement 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 employment
at former domicile, removal of family to new domicile, purchase of home, etc.) ~
,~21
593
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ST
LUCpE COUMTY FlA
ROCE~ P9~TRAS
; - CIERK Ct :CUlT COURT
~
RF~QRD Y;R:FIED
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' ~AN 6 9 06 ~ '7Z
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~ I FURTHER CERTIFY th~t 1 will comply with all other requirements of a legal resident of this State. ~
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K I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
~
~ PIERCE, SAINT LUCIE COUNTY, FLORI~A, permanently.
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~ ~ ~ /
1~
~/Y~L iP (NameZ ~f03ER
~
~ Llt~~~ ~ ~
_ , _
_ (Address) ~~,"r ~C,C
y; Swom to and subscribed before me tnis _____s1__-'~` _ day of _ , 19~
:>:i
r ~
~ ROGER POITRAS -
CLERK CIRCUtT COURT - . : N~3t#iry~,~,Public ~ ~ ~ ~
_ . ,
' - :
. . . • ~v~s Oct 29, t972 '
' BY - - - D.C. My Comrnission ezpiret ~ ~ ~
`~r (to be executed in duplicate and original fited with Clerk Ckcuit Court, and dupliuts with Tax Assessor.)
so K 198 oA~.1644
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