HomeMy WebLinkAbout0276 ~r~~laration of d~mi~il~ ~nd ~ttizer~~hlp ~
~ic~c~
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIOA:
• This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filiny fhis day in accordance and
in conformity with Cfiapter 222, Section 222.17, Florida Siatutes.
Toaesboro Geo ia
1 was formerly a lega! resident of _ _
(City) (State)
and I resi~ed at _ ~__1 _BoX fil _ _ _ i _ . _ _ _ _ . However I have changed my domiG+le
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _~-~t__________ day of
U~ec~aber 6~ Rt 2 Box 150
19~----, and I reside at
~ (Stre~t and Number)
FORT PiE'RCE, SAlNT tUC1E COUNTY, FLORl~A
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of F(nrida.
(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.) ~
~
E
~ Ehtering Jane HattaW~y in the Sth grade
:~~~'t'~
.,;.i•.~' ' _ F~~~~t~~Rl?ED .
~ ~ • ~ . ~l~~ E300K
_ i; _ . . - . s:: s_~~itt..~`c~~` ~
- - - -
, .J-." . ' ' - '66 JA~~ 3 AM !0: 33
~f: _ ' . , ' t:~
: ~ ~ " - ~ ~.41..f
~ ••Gtj' ROG'~!t ~~Ct i i;•;S, t;L~RK - -
` ~ ~ ~ST. LUCIE COUW7Y,
; ~;r:,:~~~~~~''~ FLORIDA
,
~
: I FURTHER CERTIFY that I will comply with all other requirements of a legal r2sident of this State.
i ~ '
' I FURTHER CERTIFY that I have no intention to retwn to my former domi~ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently_
I `'),t_,`e:...,';`;, - _ . ~ ~r
~
I + , •j , ~ ~
~ : ' , _ ( a e}
, ; ° : ' ~t - Betty Jonea
f~ • , - -
. J ~ J . ' . 1 •
~
' - ` ~
` ~ • ' f''~~~t~ ~ . .
- ~ - (Address)
i . ~ ~ ~ ~
i " ' ~ ~ .
' J~~t~wornlto and subscribed before me this 3~ day of _ J~~Y'Y , 19 66
RO~ER POiTi~AS
RK CtRCUtT COURT Notary Public
BY ~ D.C. M Commission ex ires
Y P
(To bs executeet in duplicate and original tiled with Clerk Circuit Covrt, and dupliute with Tax Assessor.)
- ~ooK 135 ~ 276 :