HomeMy WebLinkAbout1976 Decl~ratior~ af l3om~cile ~nd ~Citizenship ~ ~
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TO THE STATE AND COUNTY TAX ASSESSGR, ~,~~'i~~ ~ ~
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Si. tU~iE i.vUNl'Y, ~LORiD~i: '
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Tl~is is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes. ~
Montgomery % Ala. ~ ~
~ was formerly a legal resident of _ _ _ _ _ _ - - ~
(City) - (State)
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1020 Hew S t, However I have chan ed m domiCile
and I resided at - - - . . 9 Y '
(Street and Numbar)
15th
to and am and have been a bona fide resident of the State of Florida since day of
January 5~ 1105 Ave. M ~
- 19------- , and I reside ai -
(Street and Number) ~
FQRT PIERCE, SAINT LUCIE COUNTY, FLORIDA ~
and this statement is to be taken as my declaration of citizenship, actua! legal residence and domicile in ihe S~ate of Flarida. ~
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(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment ~
~OriTl~i C~Oft11~1l~, f8lTlOV3! Of fd^?!~~ t0 l1PW L~~R?irjlP~ ~~1(f{'1._ifP nf h~me, ^tC.~
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FILING FOR H~9MfiSTEAD PURPtDSES ~
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Fll~~p~RDED ~
: IN_.__ BOOK ~
~y-~,. ,,~"11,'~•i,~
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"a ~ '66 FEB i! 0 PM 2 : 28 ~
~ - . ' rr~- 1 `_~,`t~`tr~ ~
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= ~ " ` ~ ~ = RQOER YOITfZAS. Ct~ERK :
'.f 1:':~f ~ ~~T. LUCIE COUNTY.
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' - ' , ~ ~ FLORIDA
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F I FURTNER CERTIFY that I will c~mply v~ith all other requirements of a legal resident of this State. ~
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I FURTHER CERTIFY ihat { have no intention to return to my former domi4ile, and I intend to r~main in FORT ~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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,:,~;r:,, (Name)
~ ' . Mose Cald~:~ 11
','`•'a, . . ~ ,j 1 `l ~
~ ~ .~w ° "r,'. (Address)
. ~ ' _ ~ c~ r; -
' ` ; : ` lOth February 66
i•~''•~ Sw~n?tp~and subscribed before me this day of _ , 19 .
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/~,•'..:~a,'
~~~i'llfi~tt:i1~~~
RO~,ER POI S
~t~LERK IRC 1 COURT r Notary Public
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By D.C. My Commission expires
(To be execu in duplic~ta and original filed ~i1~i ~1~{~Circuit CQu~ and duplicats with TaR Assessor.)
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