HomeMy WebLinkAbout0817.. _ -,
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6UOK ~ 2U(1 JohnHle for
Declorotion of Domic le on~~~~ifiienship
TO THE STATE AND COUNTY TAX A35E9SO8,
Sa i nt Lu a i e .COUNTY, FLORIDA
Thin is my declaration of Domicile and Citizenship in the State of Florida that I am Sling this day in
accordance, and in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of______- Pipersville_________________
(City)
------------1
_-____Pean
(State)
f-gnerAi fiAl-~ VAt'V TJn~.e~,pr~ T ~.II a.A wl~°u ~r-rod jMy ~~1?!lll!112
and I resided ai - - ---- ------- -- - -
(3treet sad Number)
to and am and have been a bona Sde resident of the State of Florida since day of
January. _ --_.- -_ _- , 19_9., and I reside at ---__ 812South____-__ 6thst______-___ ____ _ -
- -- -- -------------------
(3treet and Number)
- Fort Pierce- ---------------------------------~ --------------- ~~_~Lll~ie----------- ------------------_ ___-County, Florida,
(qty)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in
the Slate of Florida.
(lnaert here any pertinent facts, such as sale o1 property or business. or relinquishment of employment at
former domicile, removal of family to new domicile, pnnhue of home. et+~)
Purchased a new home
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I FURTHER f FRTiFY that T will register at my local address when the registration books reopen,
, _---,~. ..~~ -,t. ..•w s-f ., ~n...,l rnw~.lnnt of ~{,io Q~o/_o
Aflll 1".11111}/1 ~' YYlbll ail I/~LCi i:,y u,~•i,- ,r,• v .. ..0..• .w ..- - .•- ---- - - -•
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain
• Fort Pierce - - - - -- --- -- - --- - - - ------- 3t_,_Lucie-------- ---- -- --- ---------County, Florida,
(Cityi -
permanently. . ?~~`/ ---- ~)~~--^
- -- -------------- - `~'~ f ---- --------- ----------------
(Name) 1
Sworn to and subscribed before me this-.--19_--.day of
~a nun ry----- ---- -. - -- --------. A. D. 19.61__,
o ry Pnblic State of Flosida at Larne
My Commission expires... _-d~n_15,19.84___ ~_
(To be executed in duplicate and original Sled with Clerk Oirev~t Celt*;~d~tikplt
Hov~-.+n SUDDI~ (b.. 1'len[ 0117. Fle. _. - __
_ (Address)
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with Tsz Assessor)
ate`- '.` .