HomeMy WebLinkAbout0975- ~ooK 2 3fi9
Declorotion of Domicile and Citizenship ;T•' !CIF COUNTY, ~~a.
TO THE STATE AND COUNTY TAX AS3E93OB.
ST . LIIC IE COUNTY, FLORIDA : •
This is my declaration of Domicile snd Citizenship in the State of Florida that I am filing this day in
accordance, and in conformity with Chapter 222, Section 222.1?, Florida. Statutes.
1 was formerly a legal resident of-___- I~QIIISYILLli________________ ___ -_-------KY_____________-.-.--_-._ __
(City) (state)
3IlL~ I rS3:Q'°~ 8*. 7~~n T~i„ /?w=.... a*_------ - T ~ - - -
=•l-~:~--_;.~:.,,;.;,.,,.___.___.___._____-.. _ _ .. ~,vwCVCr, ~ nave cnangea my oomicue
(3treet and NumUsr)
to and am and have been a-bona fide resident of the State of Florida since 15LIi _- _-_.._-.day of
- -- - ..----~~~ - ---•-- - ---, 19 g~.,. and I reside at -_------- -311--East'- 8t ~-~n~len__ River. E~t_$tes
FT. PIERCE '(stmt and Aiumbar.)
- ------ --- ----------- ------ ------------ ----------------- -------:3T.- LIIGITs`------------------ '------ ---- - -- ----County, Florida,
--------- --
(~ty)
and 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 u sale o! yroperty or husiness, or relinquishment of employmeat at
former domicile, removal o! family to new domicile, purchase o1 home, ete.)
FIL ~ ~,~~~~~~~~ED
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen.
and comply with au other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have nq intention to return to my former domicile, and I intend to remain
in------------- F'T. PIE_RCE ---- -- ------------ --- -- -----~ ----- ------ST-+---LUCTF---- - - ------------.County, Florida,
(City)
permanently. ~j '
(Name )
- ,.
. , _ ~ ---- -1'- ---~'-M--C-t----~`UIi!IN----------- ---- --- -- - - - -
- - -- - - -----
~ ~ ~ ~` (Address)
li,
$~-bF>1~o and•$~giscribed before me this_-_'23 _- day of
. ,.
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• ' - ~rlvaxlE=•
"'•,~• .~tOGE •~TRAS-CLE IRCIIIT COURT '
~- !~ ~ Dep. clerk
(To be rzecvted in duplicate s~d original Bled with Clerk Circuit Court. and duplicate with Taz Assessor)
1c~•a~.•n tlnunly ro. Piert ~'ia~, Fie.
vy ~'~`p
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