HomeMy WebLinkAbout1695 DeCiaration of DomiCile and Citizenship
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TO THE STATE AND COUNTY TAX ASSESSOR, , 1fi~~sSS
Sl. IUCIE COUNTY, FLORIDA: ~
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am fiiling this day in accordance and ~
~n conformity with Chapter ~22, Sectio~ ?22.17, Florida Statutes. ~
1 was formerly a legai resident of _~f``~~ ~
(City) - - - - ~ (State) ~
a nd 1 r i ~ ' ' ~
es ded at _ ' ~ _ _ _ However I have changed my domiule ;
(Street and Number)
+o and am and have been a bona fide resident of the State of Fbrida since aDy"v"!`'~~___._ day of
- _ 19~_~ and I reside at ~ l
(Street and Number)
fORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citiienship, aduat legal residence and domicile in the State of Florida.
(Inser! here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicite, removal of family to new domic~le, purchase of home, etc.)
22365$ i
Establis~ ing reaidence
a~~ ~ ~
#COR~ YFRI~~~____ ~
. ~i !1 2 s
r~ ~
~i f~ C` t _
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~ I FURTHER CERTIFY that I witl compty with all other requirements of a leyal res+dent of this State.
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I fURTHER CERTIFY that I have no intention to return to my former domic,ile, and I inten~ to remain in FORT
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PlERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~ ~/'//(~~u~~~~_~/~~/ ~
f . . •/`/i~~~-7~--~"'----=~--+---- ~
~ L (Name)
:
~ - ' :~arion B. Reed
~ .
(Address)
.
Swd~rr~to and subscribed before me this ZOtr'' day of __~'ebruarv ~ 19 72 :
i
i
ROGER POITR/lS
,,tLERK CIRCUIT COURT Notary Public
F ~
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~ BY ~ ` ` D.C. My Commission expires
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~ (To bs ex~cut~sl ie dupliut~ and original Rlsd with C{~Ic Cirwit Court, and duplicat~ with Tax Ass~ssor.)
: gao~199 PACE1by4
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