HomeMy WebLinkAbout0119 " !
Declaratian of Don~icit~ and Citizen~hip -D ~
TO THE S~~ATE AND COUNTY TF:X ASSESSOR, ~
51. lUCIE CC~UNTY, FIC~RIpA~
Tl~is is my declaration of Domicile and Citizenship in the State of Florida that I am filing tliis day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of _ «olford _Vir,gini._~
(cry> (st~t~)
z
and I resided at HU~'_leY~ __virg Lrlla 1111111t1g _ addTeSS Howe~er I have changeci ~ny domi~ile ~
(Street and Number)
6
to and am and have been a bona fide resident of the State of Florida since _ - day of
331 Barraelough Street ;
_ November 6
- , 19---_ , nd I reside ai - -
(5treet and Number)
~ORT P{ERCE, SAiNT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicife in the Sta*.e of Florida.
~
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, ~emoval of family to new domicile, purchase of home, etc.)
Establishing residence
FIL~~ EC ftDED
~N_ BOOK
, .
.
; . y . '6S JAN 27 Ph1 !2 : 53
. :
;
. ~ 14~~~34
~ _ ~ • i _ ~ - ~ _ .
: .A ; ~ ' ; • - ROGEP, F'~~ i f2~+S. CLERK
' ; - ; ~ • ~ ST. LUCIE COUNTY.
~ ~ ~ ~ FLORIDA
. . . . ~ ` a .
,'J• '~..t''', '
;
I FURTHER CERTIFY that I will comply with all other requirements of a lega) resident of this State.
I FURTHER CERTIFY that I have no intention to retu: n to my former domi~ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
: . ~ ~
• , . : ' (Name)
- Elmer Hurley
} ~ ' (Address)
~ '.r•''` • Y , 19
Sworn tti aiid ~~bscribed before me this 27 day of _ Jan ua r 6 b.
ROGER POITRAS
LERK CI iT GOURT Notary Pubiic
gy D.C. . My Commission expires
(To be executed in duplitate and original filed with Clerk Circuit Court, and dupliwte with Tax Assessor.) ~
BUUK.1,~f7 i~~ - -