HomeMy WebLinkAbout2924 ~ ~ ~ ~ ~~~~35 . ~ ' ~
~ • Deciaration of IDomicite and Citiaeet~sf~ip
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~ TO TNE STATE AND COUNTY TAX ASSESSOR, ; j
Sl, lUClE COUNTY, FLORIDA:
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This is my cleclaration of Domitile and Citizenship in the State of florida that I am filing this day in aceardante and 1'
in conformity with Chapte~ 222, Section 222.17, Florida Statutei. ~
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~ , 1 was formerly a tegal resident of ~~?1~~~1~ ~ KanSA,S ,
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' and 1 resided at ~ ROUt@ #1 - _ However f have changed my domi~ile ~
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~o artd am and hav@ been a bona fide resident of the State of florida since ~St day of
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~ December 64 P. O. B~x 486
~ , 19 , and I restde at
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FORT PIERC~, SAINT WCiE COUNTY, FLORIDA • ` 4
. and tFiis statement is to be taken as my declaration of citizenship, actual lega) residence and domicile in the Stete of Florida. ~f
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~ (Insert here any pertinent facts, such as sale of property or business, or relinquishment of empioyment
~ ~ at former domitile, r~mova! of family to new domicile, purchase of home, etcJ
_ ~ _ T~0 fiNTER CHz~.D IN SCHUOL • .
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~ ~ David Lee Keller~ llyxs old -
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* i964 DEC 31 PM 3: 33 ?
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~ : ' ; . " . ROG~R P011'RAS, CIEfiK
~ St. LUCiE CJUNTY. fLORIOA
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> i FURTNER CERTIFY that I w1U comply wlth all other requirementa of a lega) restdant o# this State.
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~ 1 FURTHER CERTIFY that I have no intention to retum to my former domi~ite, and t tntend to remain in FORT
P I E R C E, SAINT LU~IE COUNTY, FLORIDA, permanently.
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~ } ~ ~ • . (Name) Marion Keller
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~ (Addres~) F G p Box 48
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~ Sworn to and subscribed before me this 315~'~ day of B@~.~ , 19 64 3~
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~ , ~~A CtRCdF]~G.OURT - Notary Public ~ ,
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~ ~ .BY `t ~ ~t ~ ~ t D.C. My Commission expirea -
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.be~e ted in duptiate and originsl fited (~rRFi ~~~rcuit ~o ~snd dupiicstr wtth Tax AsNSSOra
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