HomeMy WebLinkAbout1997gao~ 4 23
Declaration of Domicile and Citizenship ---- ..- _..._~.
ST, LUClE-COUNT~, FLA,
TO THE STATE AND COUNTY TA% ASSS88OR.
ST. LIICIE COU>!l~'Y~ P'I~ORIDA:
This is my declaration of Domidle and -Cttisenhip in the State of Florida that I am lllin~ this day in
accordance, and in conformity with Chapter 2,22, Section 222.1?, Florida Statutes.
I was formerly a legal resident of_________~A~TS~~!I---------------------------------------. -_-1dS?.~_-----•---------------_.
~,~ ~, . s. ~ (cis) (atte>
and I resided at_ 63..., y1Y114"e __ - However; t have changed mp domicile
---
(Street a>ad Number) ,
to and am and have been a bona tide resident of the State of Florida aincP 18L _ - -_---_. day of
LARCH 81 904 Coral Awe
--------- ----------------_-------------------------. 19------_, and I reside at--=-----------------------------------------------------------------
• (8treet sad Number)
FT. PIERCE
(«~) ~._--_-- 3T. LIICIE __ -County, Florida,
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in
the State of Florida. -
..-
(Insert here say pertinent facts, such art sale of ptrl or buaiasss, or rslingnishment os employment at
forme: domicile. removal of family to new domlelle. pnrehue a~ bom•. ele.)
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I FURTHER CERTIFY that I will register at my local address when the registration hooka reopen,
and 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 domicile, and I intend to remain
~----------~'T,---PIEBCE_----------------------------------------------. --------BT~-_1.UCIE_------------------------------County, Florida,
(city)
permanently.
aa!_YYIQ(_}_ (Name) ~~~~--
,~,,,,,
,..
`~ - • :~:•. - •• ~~,' (Address) ,
Swolrn to swd Iighacrj'bed before me thia_-142'.h-day of '
~'B~FdJ/-RY' ~: =' ~f. _---------_-__, A. D. 19___61
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Ar~~K,,P'U3~LERK IRCIIIT C
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DEP. cLERg
(To be esetuted in daplidte and oriRintlQjllled wkh Clerk Circuit Court, and dnplitate with Taz Assessor)
Bowrn BupDl~ Co., Flant Clq, Fla.