HomeMy WebLinkAbout0965 D~claratian c~t bc~mi~~i~ and ~itiaenship i 3
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TO THE STATE AND COUNTY TAX ASSESSOR,
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51. LUC.It I.UU(~1 Y, rLVKIIJFN: '
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in conformity with Chapter 222, Section 222.17, Florida Statutes. ~
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I was fo~merly a legal resident of Det ro i t _ ~1i~,ch~a ; - i
(City) - (State) ;
1~404 Annchester . Howe~e~ I have chan ed m domiGile ~
and I resided at _ _ _ - 9 Y
(Street and Number) a
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to and am and have been a bona fide resident of the State of Florida since 28 day of ~
Ra.ver Yark }
De?rc?mhP r f, ~ ?L? L; ~ i uuu e.,,, ~txsc~xsr~ i
19__ and I reside at - ! i-v~
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(Street and Number) ~
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F06tT PIERCE, 5AIiVT LUCIE COUNTY, FLORIDA t
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and this statement is to be taken as my deciaration of citizenship, actual legal residence and domicile in ihe Stat~ of Florida.
(Insert here any pertinent facts, such as sale of property or business, or ralinq~ishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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FILED t~NG RECOf~DED
_ ~FfiCi~~ ?OOK
Establishin~ residence ~ ~t~~ ~ `
'6G JAEJ 18 ~1P1 .l l ~,y
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. , ;;T. LI;CI~ CC.Ut~~ i Y. i
. ~ FLORIDA ~
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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 ~
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PIERCE, SAINT LUCIE COUt~:TY, FLORIDA, permanently. ~
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` ; ~ ~ - _ ~ (Name) ~
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~ Sworn to and ~ubscribed before me this 18 - day of _ January , 19 66 ~
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; ROGER POITRAS - ;
~ CLERK RCUIT CQURT Notary Public ~
g L• D.C. My Commission expires ~
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(To be exocuted in duplicate and original filed with Clerk Circuit Court, and duplicate with Tax Assessor.)
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