HomeMy WebLinkAbout1250 Dectaration ot Domicile and Citizenship
10 THE STATE AND COIINTY TAX ASSESSpR, 235863
Sl. IUCIE COUNTY, fLORiDA:
Tl~is is my <leclaration of Domicile and Citizenship in the State of Florida that I am fil~ng this clay in accordance and
in conformity w+th Chaptcr ??2, Secticn 222.17, Florida Staiutes. ~
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I was formerly a legal res~dent of ROANOKE _ _ _PIRGIfiIA _
(City) (State)
and I resided at .__2319 TUC~C8Wtllld Cirele__N.~1.Y _ However t have changed my domiCile
^ (Street and Numbpr)
to and am and have been a bona fide resident of the State of Florida since _ ~~_th__ day of
_August i9_72_, and 1 reside at _Te~p. _3731 St. Benediet Rd
(Street and Number)
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FORT PIERCE, SAIN? LUCiE COUNTY, FLORIDA i
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and this statement is to be taken as my declaration of cititenship, actual legal residence and domicile in the State of Florida. ;
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(Insert here any pertinent facis,- such as sale of property or busi~ess, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home. etc.)
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Furniture arriving today, andr?e r?ill reside at
126 Chamberlain Blvd, St. I,ucie ~illage t
Enterinrr children in :~nooi ~ 235863
~'i F LE~ ANfl REC4Rp~p
LUCIE COUNTIf ~LA. ~
` AOCE~ ~0!TR~S
~ CL~RK C~ :~U~T COUR ~
~ RECOR~ VE~'~itED
~ . Auc 11 IZ 33 PM'~1 ~
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1 FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domiule, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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(Name) i
Donald A. Forbea " ~
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~ (Address) _
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`I Swqcn to a~d subscribed before me this 22nd day of - Au~ia t , 19 ?2
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ROGER POITI~4S
= CLERK CIRCUIt C~URT Notary Public
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By S D.C. My Commission expires
; (To be executed in duplicate and original filcd with Clerk Circuit Court, and duplicate with Tax Assessor.)
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