HomeMy WebLinkAbout1235 Deciaration of Domicile and C~izenship
_ ~ ~ 2295'78
TO THE STATE AND COUNTY TAX ASSESSOR,
_ 3t. Zucie ~UNTY, FLORiDA:
This is my declaration oi' Domicile and Citizenship i~ the State of Florida that I am filing this day in
acconiancc, and in conformity with Section 222.17, Florida Statutes.
! was formerly a legal resident of Ar111'igtori , Virginie and I
(~~r) (State)
resided at ~007 l~Orth ROChe~ter Street , However, I have changed my domicile to
(SUeet aad Number)
and am and have been a bona fide resident of the State of Florida since l~t day of
Oetober , 19 ?1 , and I reside at 602 Beach A~e. Ri~er Perk
(Street aad Number) ~
_ P't. Pieree , St. I,ucie County, Florida,
(~~r)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of F~orida.
(lnsert here any pertinent facts, such as sale ot property or busine~s, or relinquishment oi employment at former
domic~le, removal ot family to new domicile, purchase oi Aome, etc.)
Eatablishing residenee ~ 2~5~~
fiLEO AIlO RECp~p~
=t ~IICIE COUMTY fL~,
' ROCf.R P4tTAAS ~
CLERlI C1RCtJft COURT
PECORQ YfRIFIEp~.~...~~
MAr 1` f 15 PM'7Z
~
~
1 FURTHER CERTIFY that 1 will register at my local address when the registration books reopen, and
comply with all other requirements of a legal resident of this State. ~
I
' 1 FURTHER CERTIFY that 1 have no intention to retum to my former domicile, and I intend to remain in
Ft. Pierce 9t. Zucie County,
. ,
Flor.~ia,.permanently.
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5vvq~r~i;t~' .~~ubscribed before me this 16 day of Doria A. Yan ~I' er
,~,c~
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xa ~ , A.D. 19 72
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~ otuy Public State or Florida:t Lu6e
; lIOTARY tUQLIC. S1~tE ei fIORIDi1 N tARBE
i My Commission expires ~ ~~~5~ ~N~~ ,
~
~I (To be execated in duplicate sod ori6inal fded with C7erk C~cuit Court. and duplicate w6th Ta: Asfeuor)
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A(~C~i Forrti 71 ~ 22
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