HomeMy WebLinkAbout0697 _i ~ ~
~eci~aratian ot ~omicile mnd ~itixen~~ip -
TO THE STATE AND COUNTY TAX ASSESSOR, ~
Sl. IUCIE COUNTY, FIORIpA:
This is my declaration of Domiciie and Citizenship in the State of Florida that i am filing ihis day in accordance and
in conformity with Chapler 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of ~ / Salem l~nd iana
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~ (City) (State)
and I resided at _____Rt: Y~ashin tOll ~Oull~ Hc,wever 1 have chan ed m domi~ile
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(Street and Number)
io and am and have been a bona fide resident of the State of florida since 12~h _ day of
December 19 65 , and I reside at _______I109 _ChipOla Rd.
(Street ahd Number) ~
fORT PIER~E, SAINT WCIE 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.)
Ne~v Domieile ~
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~ ~~~u Aivu nr CUftDED - ~ r _ . - -
- C~Gla~--~~_300K ~ ' - ~ ~ -
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' F~i;G~:,. i'~',i ;~?i::~; C`~.i~K
~ ~T. LUC1E COUfJTY,
` ~'L(JRIDA
a
i 1 FURTHER CERTIFY that I will comply with all other requirements of a legal res~dent of this State.
~ I FURTHER CERTIFY that I have no intention to return to my former domiCi~e, and I intend to remain in FORT
~ PIERCE, SA1NT LUCIE COUNTY, FLORIDA, permanently.
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~ „ ~ : . _ Thomas Robe r t s ~
~ .T-~ _ 'q'v , _ (Name)
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, l Swom to and subscribed before me this ~2th day of - January
, 19 66 • i
ROGER POITRAS
CLERK CIRCUIT COURT Notary Public
gy 1,.._~'p`' D.C. My Commission expires
(To be executed in duplicate and original fited with Glerk Circuit Court, and dupliut~ with Tax Assesso~.)
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