HomeMy WebLinkAbout1772 i
Declaration ot Domicile and Citiaenship 22~6'~4
F
TO THE STATE AND COUNTY TAX ASSESSOR, 4
51. IUCIE COUNTY, FIORIDA:
;
This ~s my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and ~
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of Cambria~@__ _ N@~! YOr~C
(Ci ty) (State)
and 1 resided at _ T NO~t `t_ PBrk __~tTe@t _ . However I have changed my domiCile
(Street and Number)
ro anr! am and have been a bona fide resident ot the State of florida since 12th day of j
t
~
,
Noveaber iv____.7~ and 1 reside a~ _~80__Jardain Road Port St. I,uci_e '
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement 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.)
Establishing residence-
2~~s~4
ST
~UCIE COUNTYRFL~.
ROCER POITRAS
CLEaK c:,tCUrf COURT
RF~G~i L'ER+=:.'n
f _ ~ ~ l~`
t ~ T IO 3s AH 7
: ~
~
~
;
~
~
a
~
g
~ I FURTHER CERTIFY that I will comply with al) other requirements of a legal resident of this State.
~
~
~
~
- I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in FORT
~
PIERCE, SAINT IUCIE COUNTY, FLORIDA, permanently. .
: _ .
~ ~ ' y V 4 , t~ ~X
~ ~i V~,' ~ r. ~ f ~ (Name) ~
~ ' J i •
' ' ' ` ~ Jeennette Mcrrell
~ • - ~ •
y - ~
l t~ ' ; J ~ ~s) ~
. ~ , ; , ~
1
Sworn to and subscribed before me this 7th day of _ JeIIUBTY , 19 72.
r? ROGER POITRAS
- CIRCUIT GOURT Notary Public
~
'V
j .i.-~~~ .~G( ~
By - D.C. My Commission expires
._i: _
~
(To bs ~xecut~d in dupliuts snd ori~inal filad with Clerk Grcuit Cour~, and duplitats with Tax Asstssor.)
ao~K 198 PAC:1770
!Jo. I3