HomeMy WebLinkAbout2171 t
Deciaretion of Domicile Vand Citizenship '
TO THE STATE AND COUNTY TAX ASSESSOR, ~1~ .
___3~~ Zuai s _ COUNTY, FLORIDA:
This is my declaration of Domicil~ and Citizenship in the State of Flotida that 1 am tiling this day in
accordance, and in conformity with Section 222, i 7, Ftorida Statutes.
~ 1 was formerly a legal resident of ~ She~tield , Ya~~. and I
(ciey~ (st.te)
resided at _ ~i4ute ~ . However, I have changed my domicile to
(Street and Number)
and am and have been a bona fide msident of the State of Florida since day of ~
No~esber , 19_
53
_ and I reside at 1~0? St. Luois~ ~~ourt
(Strcet and Number)
Fort Pierce Hea~h , St, T.~i e County, Florida,
(~~r)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. -
(inseri here any pertinent facts, such as sale oi property or'business~ or relinquishment of employment at totme~
domicile, removat ot fsmity to new domkile, ptuchase of home, etc.)
Bstabliah I,egal Reaidence in St. T,ucie County,State oi ~'la.
lE0 AND REC
eL ROCER
PQItR~~
RECORD yEAaFiEO C~
Ant 1i 2 PM'12
I 228132 ~
i
~
~
~
~ .
,
~ .
~ 1 FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
~ compty with all other requirements of a legal resident of this State.
I
~ I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
~
~ l~ort Pierce ' ~.t. LuciR , County,
~ Fiorida, permanently. cc~ty> -
f
!
~ ame) .
~ Leeh l~aterCs ,S~l~er _ c,D1
: ~O O 7 dT - [,~/~'/G !OT .
~ (Addras)
3
' Sworn to and subscribed before me this~'~!~ day of '
~ . '.•:.••~t:t4L'~' . ~
~ L~£~'~- A. D. 19 ~ ~ - =
, . '
~
~ ROGER POITRAS, CIRCUI O~T URT - CZE ` - . ~ _
~ - t;? : . . ; c~
. ~ -
~ B = ' - ' . • '
- •
s ;'v + .
~ • • '
~
~
g (To be ezecuted in duplicate .nd ori6insl ftled with Clerk Circuit Court, snd duplieale w~ith Tu As~ea~or)
6
~
§ g~201 ~2169
~
r~~~ ~ F-: ~ ; _ .
T ~
_ ~