HomeMy WebLinkAbout0681~ o~ - z _ 7z
ST, LUCIE COUNTY~_ E A.
Declaration of Domicile and citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
3T.LtTCIE CQUNT~, FIABIDA:
•1•tis is my deciarai.iun v: I;;,micile and L`j~pn~ip in the State of Florida that I am filing this day in
accordance, and in conformity with Chapter 222, Section 222.11, Florida Statutes.
I was formerly a legal resident of_ ROCKQII.I.E _CENI'ERl__LOI!1Q_ I$T,AIJI~,__NEM-YORK -----------------
(cxal (site)
~ Ag A wr -nsnus Hndever. t have c1-an1[ed my domicile
-- _ - -
t1A4 1 2CD14G~1-1 i,~ - ---- ---------- -~ - -
. - (street sad Namber) let ___-__-- day of
to and am and have been a bona fide resident of the State b. Florida since -
1faY _ 19-~_-, and I reside at-_160__Bonita Conri~__rt~it _~t•-__~=u~ie__--
--------------------------------•--- : -- {SL^eeE a-t•1 Numbsrl
Port Pierce St. Lucie____-_________.___-_County, Florida,
--- - ------ ---------------- ------------- ---- -
- - - -- (ctty~
~nd this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in
the State of Florida. -
(Insert here any pertinent facts. such as sab of~yropertyy or business. or trlilWui+hn°ant of employment at
former domicile. remoral of tamiii to new domidle. pnrelwt e~ boast. ~•~
;~ ,,.:.... ~1~1J
_• 1
'~•~~ -•'•~ _ Fi~GER POIT
. .. ~ ,~ ~ ~. LUCIE COUNTY, F;. '.
I FURTHER CERTIFY that I will register at sty local address when the registration hooka reopen,
~~a ..,,,..,,~...~+~. ,.n ntl,Pr rent~lrements of a leital resident o! this State.
I FURTHER CERTIFY that I have no intentiaat to return to r0.Y loaner domicile, and I intend to remain
Port Piera a 3t . Luo i e _______~,~,~ Florida,
•^ _____------- (city) - ----- ~
permanently. . s~~ -~%--J_____
-~
_ (xam.)
Jane 8. lfhite
(Ada~••l
Swann to and subsc:i,4ed''6'~o~rb nne this---14---dal- a! -
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(Te bt - ' ~ '~jti :~ el.d wlfi a.e>< t2eeoie -eoaiek sae auFikatt witk Tat As...os)
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