HomeMy WebLinkAbout0127 Declaration ot Domicile and Citizenship
222603
TO THE STATE AND COUNTY TAX ASSESSUR,
51. LUCIE COUNTY, FLORIDA:
This ~s my declaration of Domicile and Citizensh~p in the State of Florida that I am fel,ng this day in accordance and
:n canformity with Chapter 222, Section 2?2.17, Florida Statutes.
I was formerly a legal resident of ~Yf te Aleba~A
-~Ciry) _ (State)
and I resided at ROUt@ ~ P.~ • BOZ ~ 63 However f have changed my domiCile
(Street and Number)
io and am and have been a bona fide resident of the State of Florida since ~ ~t~. _ day of
~~cember ,~9_7~ , and I reside a~ _ 3201_ Rid~ehaven Rd., ~'t_. Pierce:~'1.
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA ~
and this statement is to be t~ken as my decla~ation of citizenship, actual lega) 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.)
222603
RESIDEYCE t
~
FILEO A4@ 9ci,GRDEO
ST. IUCiE COL'NTY ftA.
RO~cr, ?vITRAS
CLfF!c ;,:•'~UIT COURT
- . P.fCO~b Y-~ Fl~p~~~
,~ur 2 i4 PH'11
` ~
~ ~
i
4
3
t
¢ '
i
t ~ 7
R
~
~v
7 ~
~a ~
~ I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State. _
w
~ ~
~ t FURTHER CERTIFY that I have no intention to~turn to my former domic,ile, and I"n nd to remain in FORT ;
~ PIERCE, SAMT LUCIE COUNTY, FLORIDA, permanent{y. jG~!~ ' ;
~S / _ / ~ ;
/
~ -7 ~
ELVIE ~i. STANFORD i
``j1~~tI~1~1.1i~ _ _ _ _ _ f
~ ' .~.j ~ : j j~ (Name) ~
, , . :
~ `~'.~:v R~ ~ ~ ~ • ~
~ W~„~~ S
p:~` _ 3201 Ridgeha~en Road , Ft . Pi erc e, Fl . ;
~a - A~ ~ ~ (Address) 33~ JO 4
' ~ , ? • • = :
• - . r.
'
• v !
ti~ ' l ~ ~
~roy~ ~td~and subscribed before me this 24th day of - Januar~ , ~q 72
_
'-3 ROGER POITRAS -
K RCUIT COURT Notary Public ;
_ ~ ;
- By \ ' _'~~`~2~~ _ D.C. My Commission expires '
~ ~
I
_ _
(To be oxocut~d in duplicato and o~iginsl filed with Gerk Cirwit Court, and duplicate with Tax Assessor.) i
s~x 199 t~~~ 12? '
~:0 13