HomeMy WebLinkAbout1976 Declaration ot Domiciie and Cltizenship
TO TNE STATE ANlD COUNTY TAX ASSESSOR, ~
51. IUCIE COUNTY. F~oR~oA~ 2218~
Th~s ~s my deciaration of Domiule and Citi2ensh~p in the Sta~e of Florida that I am filing this day in accordance and
~n conformity w~th Chapter 222, Sect~on 222.17, Flarida Statutes. .
I was formerly a legal res~dent of `.~..~~.`~-t~- r~ r;----
(City) ~ (State)
and I resided at . ~c~ _ However I have changed my domicu~e
(Street and Number)
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!o and am and have been a bona fide resident of the State of Florida since _ day of
' ~ 1
- - . 19___ , and I reside at ~'~'i:. - ~'-s.:~c : i,,, ~ 1 .-,~,r _ _ _ -
(Street and Number) ~
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FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA t
and th~s 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.)
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~ F11E0 AND RECORDEO ~ ~
~ ST. WCIE GOUNTY FLA.
i aOCtR PO1TaA5 l
CtERK CIACU?T COUI1?
; RECORC VER+FIED
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3~ I FURTHER CERTIFY that I wil) compiy with all other requiremenis of a legal resident of this State.
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~ I FURTHER CERTIFY that 1 have no intention to return to my former domicile, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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,4 l~_~ce.t. ~.1. ~ ~i!
~ . = Name) __-T
~ - " ~ w ay n, . C~ ~
~ _ ~ (Address)
- _ . ' ' . ' : -
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~'S~vqitii~~~i~jd~subscribed befo~e me this day of ' ---~u . , 19~~~'
• , . l~
_ ROGER POITRAS - -
_ CLERK CIRCUIT COURT Notary Public ~
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3y - ~ _ D.C. My Commission expires
(To be executed in dupliuts and oripinsl ~iled with Cls~k Girc~it Gourf, and dupliut~ with Ta~c Ass~ssor.)
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