HomeMy WebLinkAbout1013 . , . . ~ . _ . . ~ i
~ le and Clti~~nship ~
Deciaratt~n of Dom1c0
TO THE STATE AND COUiVTY TAX ASSESSOR, 13~.~.QS '
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ST. IUCtE COUNTY, FL~RIDA: ~ 4_
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Thls is my detlaratlon af ~omicile and Citizenship in the State of Florida that I am filin~ this dey in actordance~ end ~
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in conformity with Chapter 222, Seetion 222.17, Flo,rida Statuies. r
I was formerly a Isgal resideM of Sht11bYY'=~,~~
(Ciry) (State)
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and 1 rostded at ROUtt ~4, . Howaver 1 heve thangad my dvm~cJle
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to and am and have been a bona fide resident of the State of Floridb since 28t1L day o1`
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i - NoY~m~e r 14~~-, end I reside at 2307 Hl~~AhPt ~P..
(Streat and Number)
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! !°ORT PI~RCE, SAINT LUCIE COUNTY~ ~LORIDA '
' and this statement is io be taken as my cietla~ation of citizanship, actual lega) residence and domlclle tn the State of Horida.
(insert hera any pertinenc fads, such as sale of Rcoperry or business, or ~elinquiahment of employment
~ at fo~mer domicile, removai of family to new domicile, purchase of home, etc.)
; Place Lhildren in ~chooJ. ' .
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; s~sa~ Ma~.iozy ia yrs. 8th Grade :L~1~Q~ .
` - ' FI~ED AND RECORDED -
: Sa11p Mallorq " " " ~
, , ~IN ' ' DOOK .
l964 NOV 30 PM 12: 40 ~
' _ ROGER POITRAS, CLEflK
, ~ ST. LU~IE COUMTY, F~ORIO~~
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i~lRTHER CE~tTIFY that i wlll oomply wlth ail athar requirementa of a le~al resident of tt~is Stete.
, . i FURTHER CERTIFY that i heve ~o intention to roturn tv my farmer domi~ile, and 1 intand to remain tn FORT
p1ERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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, (Name) Mox s"Ma.llorj
' ; ~307 $liaabeth Ave. , Ft. Pierce, P1 ~
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~ . 5~?~p,~, nd wbsuibsd before me tht~ _ 34th day of - _Novtmber . 19 6~ •
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~ t ~ ~t ~ , ~ Notary Public . .
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~ ~ ~ ~ D.C. My Commis:ion explras
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t{ ~ (To b~ ~xocut~d in, dupi#ca~~ and ori~i~al -fiNd wkh Cis~ic t~wh Cour~, ~~a a~k.~. ~ T•~ ~a
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