HomeMy WebLinkAbout0118 Declaration of Domicile and Citiienship
"TU Ttit: STAT~ ANU ('OUNTY TAX ASSESSOR, ~~rAA
St. I,ucie Count
__~_~OUNTY, FLORIDA:
This is my drelaration of Domicilc and Citizenship in the State Fl~rida that l am filing this day in
acconlancc, and in conformity with Section 222.17, Florida Statutes.
1 w~s formerly a Iegal resident of Rradentp~; Florids and I~
(c:lr) . (state>
n:sided at 3.Q.Q_4 Ri~?er~ieR ~lvd . . However, 1 have changed my domicile to
(Street and Number)
and am and have been a bona fide resident of the State of Florida since ls t day of
January , ~q_ 51 and 1 reside at 4111 S. Indian Rirer Dri~e
(Street and Number)
1~'ort Pierce , St . I,ucie County, Florida,
(a~y)
and this statement is to be taken as my declaration of citizenship, actual legal residen~P and domicile in the State
of
Florida.
(Insert here any pertinent facts, such u sale of property or business, or relinquithment of employment at former
domicile, removal of (amily to aew domicile, purchase of home, etc.)
I am the nother of Alice Armanda Horton, Age 18, ~ho is
applying for the Adrian M. San?ple Scholarship. She is
a perm~::~~t resident of St. Lucie County, P,egistered in
said county~ pr_e~entll enrolled at Florida State Unirersity,
Tallahaasee, Florida. ~
i~~~{{CIE COUN~Y flA•
~ocER paTa?S c~
CLERK CIRCUIT COUIlT ~
RECOR~ VER~FIEO
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1 FURTHER CERTIFY that 1 wil! register at my local address when the registration books reopen, and
comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intentian to return to my former domicile, and I intenc~ to remain in
Fort Pi~.r _.~e, ~t Luc e ; County,
F~pri~~'t1~p]anendy. cc~~r~
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~ , i ~ ~f ~ ~ ' Name
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• y,~ - ~ ~ ean R. Norton ~
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t~;~~ = 4111 S. Indian Ri~er Dri~e
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$wti~d~~~~Ct~'~~~bscribed before me this ~ day of
A. D. 19 .
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N uy Public State of Florida lar6e
~ My Commission expires ~ - ~G ~'~3 - ~OOII~rV1 ~
(To be executed in dupiitale and original fJed with Ckrk Circuit Court, and duplicate with Tax Assessor)
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