HomeMy WebLinkAbout2346 2220'78
aeclaration of Domicile and CitiYenship
TO THE STATE AND COt1NTY TAX ASSESSOR,
,
51. LUCIE COUNTY, FIORIDA
Th~s ~s my detlaraNon of Domiule and Cit~zenship in the State of Florida that I am f~l~ng this day in accorda~ce and
,n conformity with Chapter ?22, Section 222.17, Fiorida Statutes.
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1 was formerly a legal resident of _ _ _ _ . _ ;
(City) te) ;
and I resided at z,_--~ `___~J'_3~_`_`"~~ Nowever 1 have changed my domiCile
(Sireet and Number)
to and am and have been a bona fide residem of the State of Florida since day of
~ , _ ~ 1
T'r . .`~c 19~! , and I reside at `'C ~ . ` l~ z -P-~-~-wZi C.-~-t _ - -
(Street and Number)
FORT PIERCE, SAINT lUC1E COUNTY, F~ORIDA
and this statement ;s to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Fiorida.
(Insert here any Fiertinent facts, such as sale of property or business, or relinGuishment of employment
at former dornicile, removal of #amily to new domicile, purchase of home, etc.}
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~ 2220'78
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E _ fILEO R`!U RECOR~EQ
. S7.lUC+r ~JUMTY FlA_
~ ROGE~ r~?'RAS
~ C±~~.r.C~=GU1~ COUR
RE^C,cn yc:;Ir E~
~ ,liui 13 2 4s PM'71
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~ 1 FURTHER CERTIFY that I will comply with al) other requirements of a(egal resident of this State.
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g I FURTHER CERi1FY that I have no intention to return to my former domiCule, and I intend to remain in FORT
- PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. HER~~ S. BO~~
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y . ~ , ~ (Name)
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Sworn to and subscribed before me this - day of . 19 7 Z ~
ROGER POITRAS -
CLERK CIRCUIT COURT Notary Public
,
_ By D.C. My Commission expires
s~;
~ (To bs ~xecuted in dupliut~ snd ori~inal ~iled witl~ Cbrk G~cuit Court, and duplicst~ with Tax Ass~ssor.)
13 °~cK198 Pac~~43
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