HomeMy WebLinkAbout1251 Declaratian ot Domicite and CitiY~:nship
TO THC STATE ANO COUNTY TAX ASSESSOR, ~~CQC A
ua~v V •3
51. lUC1E COUNTY, FIORIDA:
This is my declarahon of Domicile and Citizensh~p in the State of Florida that 1 am filing this day in accordance and
~n con(ormity wiih Chapter 222, Section ?22.17, Florida Siatutes
( was formerly a iegal res~denr of l le Vernon_._ _ _ _ _ _ _ _ ~Pa ~__..r_ -
~ (City) (Stare)
and I resided at __BOX_ 4__,___ . Howeve~ 1 have changed my domiCile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida si~ce 1 S t _ day of
__~u_gust ~9
72__, and I reside a~ __Bad~er Trailer Court-6407 So Fed Hwy
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA _
and this statement is to be taken as my declaration of citize~ship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or bvsiness, or relinquishment of employment
at former domicile, removal of family to ne~v domicile, purchase of home, etc.)
Entering child in school -
Laurie Ann Blai:r - 8 years
235864
,
~~~LUCA~ COUNTY /L~.
~ . RocEa ~a~T~~~
CLERK C'•~CU~T COUA~,~ ~ .
, ~~coao veF~F~co~....,,,_,
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~ a~ z1 I 14 PM ~~z .
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1 FURTHER CERTIFY 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 domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORI~A, permanently. -
rJVJ~L~/~~^~'v
(Name) David Blair
~ ' b408 S. Federal 4w~
~ (Address)
Sworn to and subscribed before me this 2 day of Augus t , ~ q ~ 2.
. - • S .
R~~ER POiTltASj. , - -
l:LERK CIRCUI~f COURT Notary Public
t -
By , ' s D.C. My Commission expires
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~ (To bA execufed in duplicate and original filed with Cle~k Circuit Court, and duplicafe with Tax Assesso~.)
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