HomeMy WebLinkAbout0041 ~
~ecl~rati~n of ~orr~ieile andl ~itiz~nshi~ ~
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TO TtiE STATE AND CC)UNTY TAX E~SSESSOR,
Si. IUCIE COUNTY, FLORIDA:
This is my declaration ~f Dornicile and Citizenship in the State of Florida that I am filing ihis day in accordance and
lil ~C~IIfUT~lit~/ 1iVitii C1ia~'iic~( «2, .~icCiiuii «~.2i, ~iviiC~~ ~1~i~Ut25.
WHITE L~KB NORTH CAROLINA
I was formerly a legal resident of _ - _ -
(City) (State)
Box 905 Blizabethtown
and I resided at - - - - - _ . However I have changed my domiGile S
(Street and Number)
to and am and have been a bona fide resident of the State of florida since __1_ day of
June 65 9203 S. jndian River Drive
- 19---, and I reside at
(Street and Number)
F~RT PIERCE, SAINT LUClE 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, s~ch as sale of property or business, or retinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
~?F~~C~ R~~rO,' F~ D E D
- ROOK
'66 JAN 2 S A~~ I I: 2 0
~-~2~~5
Establishin~ residence ROGER ~UI~i F~AS, CLERK
ST. I.UCIE COUNTY,
FLORIDA
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~ I FURTHER CEK1iFY that I will comply with all other requirements of a legal resident o~~this,~S~~~if~;~:`; :
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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 COUNTY, FLORIDA, permanently. (
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~ ~ ` ~ ' ~ , • . , As+ ~~~Z,_~
. . . ~ (Name
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, ' william H. Andrews, III
. ~ • ~ :~:v~ (Address) -
- .....:`t~~ 66
. ~ 25 January
Sworn to and subscribed before me this - day of - , 19 .
ROGER POITitAS
w CLERK CUIT C URT Notary Public
8y i _ D.C. My Commission expires
(To be exeeuted in duplieate and original filed with Clerk Cireuit Court, and duplieate verith Tax Assesso~.)
600K :.,s. ~ -