HomeMy WebLinkAbout2043 ;i `~'rf;;~
~~cl~ration ~t l7c~micile and Citiz~nst~ip
TO THE STATE AND COUNTY TAX ASSESSOR, " ~
4
JI . LVI.IL CV~IV i i~ ~~V~ivii:
T{~is is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
in conformity ~vith Chapter 222, Section 222.17, Florida Statutes.
~um~err S~ Caaol.ina ~
I was formerly a legal resident of _ _ _ - _ - - i
(City) (Sfat~) i
r
,
and I resided at _ 392 Albtrt_ Drive _ . . However I have changed my domiCile
(Street and Number)
tv and am and have been a bona fide resident of the State of Florida since ?~h__ day of
~ . ~
y ?13 E~. Rancho Drive . ~
F~bIU1]C ~9_6_6., and f reside at ~
_ - - -
(Street and Num6er) +
i
FORT PIERCE, 5AlNY LUCIE COUNTY, FLORIDA ~
~
and this staiement is to be taken as my declaration of citizenship, actual legal ~esidence and domicile in the State of Florida. ;
(Insert i~ere any pertinent facts, such as sale of property or business, or relinquishment of employment ;
s
~
a? fnrmnr rlnm~rilP rPmnval ~f familv tn new C~OR11fIIB. DUlCF1dSE' of home. etc.l ~
chaol :~;:•~~:~.r.:
Two Chilre~n enterin~ s ~
. .•~`~i~` ; ,
r4~chael L, Borchers - , ~
~ : . , . ~ i
David A. Borchers f-- ~ T'
, ,
- ~si..~ i
- _ ~1~;.~~~,rr ~
~ ~ , ~ • . • ~
. _ -
FI ,p q REC RDED ~
I ti-.~~~I~i~~ 0 0 K
~'~~~a-o-- ~
'66 FEB I I PM I2 : 0 Q ~
~ `~'~E~S
ROGER f'01~~ rC4S. CLERK - ;
~T. LUCIE COUNTY, ~
F~ORtDA
I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
~
I FURTHER CERTIFY that I have no intention to return to my former domiSile, and I intend to remain in FORT ~
PIERCE, SAINT LUCiE COUNTY, FLORIDA, permanently. j
~ ~ ~ ~ ~ . . Elizabeth A. Borchers
. ~ . * -
: ' (Name) ~
. • , _ i
~ ,
~ : . ~ ~ ;
. .r ~ a~~--
: ~ ~
(Address) '
( , ~ i
r~ befor me this 11th _ da of _ Februar.y ~ 19 66 ~
Sworn to and subsc ibed e y t
ROGER POITRAS - -
CLERK CIRCUIT COJRT Notary Public
B y~,%
'=~tG~ D.C. My Commission expires
Y
(To ba executed in duplicate ~nd original fited with Clerk Cirruit Court, and ciuplicate with Tax Aasessar.)
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