HomeMy WebLinkAbout2066 t
Declaratio~ of Dor~~cile ~~d Ci4izensQ~ip ~
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TO THE STATE ANn COUNTY TAX ASSESSOR,
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This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and !
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in conformity with Chapter 222, Section 222.17, Florida Statutes. f
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I was formerly a legal resident of D~I~ G~•
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(City) (State)
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and I resided at __r u"~._ 1~ - . However I have changed my domiGile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since lSt day of '
Feb; 66 p O. Box 352?
_ - - , 19----, and I reside at
(Street and Number)
FORT PIERC~, SAIN? LUCIE GOUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in ihe State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employinent
at former domicile, removal of fami~y to new domicile, purchase of home, etc.)
ENrERING Tti~U ( 2) CHILDREN IN PHBLIC S(;HGOIS
DAYTOy WAYNS PEARSON (8 yrs) ~N~~E~.AND RECORpEp
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DAV I D WADE PEARSUN ( 6 yr s) B~ 4 K
'66 FEB I y~~
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` rfOVEr~ Dr s -
3T. LUC1E FCO~N LERK -
{ FIOR(DA TY.
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F I FUR7HER CERTIFY that I will comply with all other requirements of a legal resid8nt.'9f: this State.
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I FURTHER C~RTIFY that I have no iniention to return to my former domi~ile, and I int~nd_ ~o! reTr(~in ~in FORT
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~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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, ~,"~~~.r~, (Name) , i
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• ~ ` 14~h February ~ 19 66
, . •~werrl:~tq and subscribed before me this _ day of - - , • ~
, . , ~
ROGER P T4tAS _
CLER CI C IT COURT Notary Public
By _ D.C. My Commission expires
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(To be executed in duplicate and priginal filed with Clerk Circuit Court, and duplicate with Tax Assessor.) ~
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BooK 38 260