HomeMy WebLinkAbout0050 Declaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, ~~~5~~,
Si. LUCIE COUNTY, FIORIDA
Th~s ~s my declarat~on ot Domiule and Cit~zenship in the Staie of Flor~da thar 1 am f~l~ng this day ~n accordance and
n conformity w~th Chapter 222, Sect~on ??2.17. Flor~da Statutes
t was formerly a legal res~dent of ATZANTA _ G~.CRGIA _
(City) (State)
and 1 resided at 4~9~ Canby Zane, Decat~r_i ~8. _ However I have changed my domi~ile
(Street and Number)
~o and am and have been a bona fide resident of the State of Florida since 6~h day of
~?t~guat ~q7~ , and I reside a, 4705 Oleander A~e._t F.P.
~ {Street and Number)
FORT PIERCE, SAINT lUC1E COUNTY, FLORIDA
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 pert~nent facis, such as sale of property or business, or relinquishment of empfoyment
at former domiu~e, removal of family to new domicile, purchase of home, etc.)
~esidence
f1~E.D f~C~~iDED
sT_ L1iC,i :;3?11liT FLA. /
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~ I FURTHER CERTIFY that I will comply with al) other requirements of a legal resident of this State.
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I FURTHER CERTIFY ihat I have no intention to return to my former domic,ile, and I intend to remain in FORT
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PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently_ /
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F I~RS. ~PILI,IA]L R. LAYBERT
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(Name) 3
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~ t,~~',...C,~`%, e 470~ Oleander A~e. , Ft. Pierce,Fla. #
~ ~~4`~S~..R •~~CG 9~== ' (Address) 3'5450 F
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_ iA' • _ - s~sv~d before me th~s _ day of ~$~'1~~--- - - , 19~_ .
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4~~ ,,~~E ~ ,T cOURT Notar P::blic ^
= gy D.C. My Commission expires
',y~ (To be executed in duplicate and originsl filed with Clerk Circuit Court, snd duplicata with Tax Assessar.)
, ~ ..a „ scaK 199 F„~E 50
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