HomeMy WebLinkAbout2521 . 4~
Declaration of Do~nicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, ~~2
Sl. IUCIE COUNTY, FLORIDA:
This is my declaration of Domicite and Citizenship in the S!ate of Florida that I am filing this day in accordance and
in confo~mity with Chapter 222, Section 222.17, Florida Statutes.
Palmetto Georgia i?
I was fo~merly a legal resident of - -
(Ciy) (State)
Rou+e 2
and 1 ~esided at However I have changed my domiule
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since J~_ 27-- - day of
i9~~_, and I res~de at !~12_ Olean~er Ave., ~ Ft rierce, Fla.__
(Street and Number)
f4RT PIERCE, SAINT LUCIE COUNTY, FLORIDA '
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
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(Insert~ here any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
_homeatead purposea p e
~~~1 IE C~~M?Y fLA.
~~C~R CU T CO aT
' C~ERK C1R
RECOaQ YE'ti1E0
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1 FURTHE~t CERTIFY tfiat 1 will oomply with all other requireme~ts of a legal resident of this State.
1 FURTNER CERTIFY that~ I have no intentio'n~to return to my former domicjle, and I intend to remain in FORT
PiERCE, SAINT LUCIE COUNTY, FLORIDA, permanently_
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~r;j~ ~ ,~t ~ron I,. ~~~r
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- ' ~ : . ~ ; 2~ ~ (Address)
f IJ .aT ' .
~ . = 28 Y`s-rch 19 72
'~$~r~-1o `~nd subscribed before me this day of , -
~b.~
ROGER POITRAS
CLERK CIRCUIT COt1RT Notary ~ublic
8y D.C. My Commission expires
(To bs ~x~cutad in dvpliut~ and ori~ina! Rl~d witb Clarlc Cireuit Cour~, snd duplicats with Tax Ass~ssor.)
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n,-~ No. 13 A
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