HomeMy WebLinkAbout1477 ~ - - - - -
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Declaration ot ~omicile anti Citiz~n~hip { j ~
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TO THE STA7E AND COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FLORIDA:
Tt~is is my declaration of Domicile and Citizenship in tt~e State ef Florida ihat I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I ~vas formerly a legal residenf of Kingsport. ~ Tennessee ;
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(City) (State)
and I resided at _ 901 Lyngarden Drive
- . However i have changed my domiSile
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to and am and have been a bona fide resident of the State of Florida since day of ~
December 65 310 N 14th Street ~
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FORt PIERCE, SAlNT LUClE COUNTY, FLORIDA !
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in ihe State of Florida.
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(Insert here any pertinent facts, such as saie of property or business, or relinquishment of employmeni ~
at former domicile, removal of family to ne~v domicile, purchase of home, etc.) ` ~
F'IL N EG DEO ~
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'66 JAN 3 i AM 0.: 5 8 ~
Estahlishing residence
~ ROGEf: ,~vl ~ lZj~S. CI.ERK ~
ST. LUCIE COUNTY, ~
FI~ORIDA
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I FURTHER CERTIFY that I v~ill compfy with all other requirements of a lega( resident pf -fhis•~ye;..~'~~~ `T~'
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I FURTNER CERTlFY that 1 have no intention to return to my former domi~ile, and I intend fi5~ remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ,
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. ` (Name) i
~ : , ~ ' • f Maurice Sensabaugh
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i January 56 ~
S~nr~i'tci.~n~ subscribed before me this 31 day of „ ~ , ~q , i
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ROGER POITRAS
CLERK C!R T COURT Notary Public
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$Y D.C. My Commission expires
(To be executed in duplicate and origina! filed with Clsrk Circuit Court, and duplitate with Tax Assessor.) ~
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