HomeMy WebLinkAbout0846 Declarati~n of i~~rri~cile and c~itiz~nship ~
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TO TNE STATE AND COUNTY TAX ASSESSOR, ~ ti~~"U
51. LUCIE CQ!
~NTY, FLORIDA:
This ~s my declaration oi Domicile and Citizenship in the State oi florida that I am filing this day in accordance and
in conformity w•ith Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of EaXp~ _ _ _ __ArkariS3S--- - ~
(City) (State)
and I resided at _ _ Rt 3 _ _ _ _ - _ - . However I have changed my domi~ile ~
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since ~rd day of
January 66 Dixie .~~obile Homes .
_ . 14__ _ , and I reside at _ :
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legat residence and domicile in ihe State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishrnent of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
,`Fi~~ ~.AND REC~~DEp .
Enterin?7 children in school ~~j~~~~-~y~4~'d---E00 `
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one in }dhite city 17 ~M I0: 02 '
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t~ in Jro High - !
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L' ~i. C~~RK ~
- . ~ _ FI.OR pAr.~'VTY, ;
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I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State. ;
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I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT ~
nl«l/"C CAIAIT II1r'~C ('ll11PITV G~vD:~A nrm~nor~f~~i
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~ ,~'~.a~.~." :i - - (Name) ; s
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_ . <<. ~ ` ~ = Lo i s Lo n g ~
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' ..SwoFii ~to and subscribed before me this ___1Z~1L-__ day of -~~.riLid.Lv , 19~_. ~
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R GER POlTRAS - ~
ERK CIRCUIT C URT . Notary Public ~
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~ gy ~-'1 e"" D.C. My Commission expires ~
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; (To be executed in duplicate and original filed with Clerk Circuit Court, and duplicate with Tax Assessor.) ~
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