HomeMy WebLinkAbout0850 , Declaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, . 242131
51. lUC1E COUNTY, FIORIDA:
This ~s my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
~n conformity with Chapte~ 222, Section 222.17, Florida Statutes.
I was formeriy a legal resident of North Adams Mass .
--(City? (State)
and I res~ded at 25 Westetld Terrace However I have changed my domiCile
(Street and Number)
~o and am and have been a bona fide resident of the State of Florida since 1 S t day of _
Nov ~q_ and I reside ar _4 Kasaba Lane, _ Spanish Lakes _
~ (Street and Numbe~)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and 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.)
i
ST~~'~~D ~EC~OFO
Establishing residence R~
{ ~ott~ 4
~ RF ORn COURT
N~l 15 - ~
3 09 pH ~lZ ~
242131
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I FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this 5tate.
I FURTHER CERTIFY that I have no intention to return to my former domi~ile, dnd I intend to remain in FORT
PlERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
. -
_ _ ~ (Name)
~ . . Robert O. Ackerly
- - .~_-?~j~ - ~
~ ' ~ 't. (Address)
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~ ~S'viloY~~~to and subscribed before me this 1Sth day of NOVember___ ,~q 72.
~
~ ROGER POITRAS
~ LERK CIRCUIT COURT Notary Public
ey D.C. My Commission expires
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(To be executed in duplicate and original filed with tlerk Circuit Court, snd dupliute with Tax Assessor.)
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