HomeMy WebLinkAbout0913 - - . _ - - - - - -
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tae~laration ~f ~omir~ile an~i ~~tizenship ,j7
TQ THE STATE AND COUNTY tAX ASSESSOR, ~ i'~ ~
Sl. IUCiE COUNTY, FLORIDA: ~
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This is my declaration of Domicile and Citizenship in the State oF Florida that I am filiny this day in accordance and ~
in conformity ~vith Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of - _~~SOn - _ _ _ --i---~[L'1~._~~glp~jgt21-rQ '
(City) (State) ~
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and 1 resided at GOSSV ill~ . However I have changed my domi~ile
(Street and Number)
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to and am and have been a bona fide resident of the Sfate of Flo~ida since _ ljth day ot ~
Janaury - _ 1966 , and I reside a~ _ _1212. llayman__Aate_ - ~
(Street and Number) ~
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FORT PIERCE, 5AINT lUCIE COUNTY, FlORIDA ~
and tl~is statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida. i
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment ~
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at former domicile, removal of family to ne~v domiciie, purchase oi nome, eic.j ;
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~ntering children in schoo2 ;
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I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State. i
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i FURTHER CERTtFY that I have no intention to return to my former domi~ile, and 1 infend to remain in FOR7 ~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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- t~ (Name) ~
" Joan Todd ~
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• v v - . - - (Address) '
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i"S'yyor~ ta and subscribed before me this da of ---,Ianaury ~ ~q~5 ~
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ROGER POItRAS ~
ERK CIRCUtT COURT Notary Public ~
B~" D.C. My Commission expires ~
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(To be executed in duplicate and ariginal filed with Clerk Circuit Caurt, and duplicale with Tax Assessgr,) ~
BOOK 136 30~ ~ ~
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