HomeMy WebLinkAbout1335 Oeciaration ot Domicile and Citisenship ~
TO THE STATE AND COUNTY TAX ASSESSOR, , ~?~6'~Q
a~
Sl. LUCIE COUNTY, FLORIDA: ~
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal ~esident of _ Td"~' _ - ' -
(Ciy) . (State)
6 0 ~ ~.t sr-
~^d 1 resided at t--------- - Nowever 1 have changed my darniule
(Street and Number)
S ^
to and am and have been a bona fide resident of the State of Florida since _ day of
_ ~ - 19 and I reside at S, ` ~ ~ G L ~ _ - _ _
~ (St~eet and Number)
fORT PIERCE, SAINT LUCIE COUNTY, RORIDA ~
and this statement is to be taken as my declaration of citizenship, actual legal residence a~d 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.)
o`~''''~ ,~~~,t~~~ ~o.rT ..1"T ~~i c~-
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~~~l G? ~r~ ~G fi~rr•-Li~°'~7pvT'- G. o it •
G.Po ~ /3 7 ~ ,B,(o /6a o ~ ~or , _
f4LED AMO RE~ R ~
f7. LUCIE C011M~ ~
' CIE~K C{aCU1T CO=IiRT ~y
~ RECORd VER1flE0...+'~"
E ~ 9 yy ~ •~z
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I FURTHER CH2TIFY that I will comply with all other requirements of a legal resident of this State.
1 FURTHER CERTIFY that I have no intention to return to my former domic~le, and 1 intend to remain in FORT
PlERCE, SAINT ~I~:COUNTY, FIORIDA, permanently. ,
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(Name) _
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Swom~fo and suburibed before me this F day , 19 72 .
~ . .
ROGER POITRAS • _ _
CLERK CIRCUIT COURT j¢~y~j R. SILVHRSI`f.°~ ~I.~11'1R, MSC~ ADkT[1TANT
2d GFN~RAL HOSPImAL, APO NEW YORK 09180 ;
ey D.C. My Commission expires !
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(To be execut~d in duplicaM snd ori~insl filsd with ~lerk Cirarit Court, and duplieat~ with Tax Ass~sior.)
„ ao~201 ~1333
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