HomeMy WebLinkAbout0960 . ~ ~ ~
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' Deci~rat~on o~ Domicil~ anc~ Citlz~r~~hip ~
TO TH~ STATE AND COUNTY TAX ASSESSOR, C ~
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ST, IUCIE COUNTY, FLORIDA: ~
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This is my deciaration of Domicile and Citizenship in the Stata t~f florida that I am filinti ihis day In aaordance and ~
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in conformity w(th Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal residenYof Valdalia Louisiana
(Ciry) (State) t
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7 Fiorida Street ~ `
and i ~eslded at . Howover 1 hava changed my domtcJle
. (Street and Number)
to and am and have been a bona fide eesident of the State of Florida since x~~ ~ day of
September 64 2715 S, 4th Stxeet
, 19 , and 1 reside at
(Street and Number)
FORT r1EItCE, SAtNT RUClE COUNTY, FtOitIDA ~
and this atatement is tp be taken as my declaration of citizenship, actuaf legal residence and domitile (n the Sta4e of Ffortde..
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(Inaert here any pertinent facts, such as sale of prope~ty or busines:, or relinquishment of employmenf
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_ at former domicile, ~emoval of family to new ~domicile, purchase of home, otc.)
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- " - ~ F ~~4ND R~CORDED , .
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~ , ~ !N ~c~, DOOK .
~ Establishi n r~sideece 1964 NOV 28 AM 10: 22
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~ ~ ' ROGER POITRAS. CIERK •
? ST. IU~iE COUNTY. FtORiDt~ .
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~ 1 FURTHER CHtTIFY that i will oomply with all other requlrement; of s leyai r~(dent of "t~l~6w1e!'
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~ 1 FURTHER CERTIFY that I have rto tntention to return to my former domiGle, and 1 intsnd to rsmain in FORT
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; PIERCE, SAINT LUCIE COUNTY, FLORIDA; permariently.
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, . •.-;~'~~,~,~,•~y W~C. Montgomery
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`t Sworn to and :ubsuibed bofore m~ thi: day af , 19 .
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ROGER P0ITRAS - -
GLERK C ~T COtJRT ' Notary Public ~ .
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` gy D.C. ~ - My Commission exptres
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j (To br ~x~cuhd in dupiluh ind ort~inal fll~d with Cie~lc Cira~it GwM, •nd duptical~ wiM~ Tax Aa~o~rJ ~
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