HomeMy WebLinkAbout0200Declaration of Dor;licile anc, L,itizenship
- ~,'~RK ~ ~~ PAGE~OU
TO TILE STATE AND CCUNTY TA\ AS`:F:5SOR,
'I'. LCC12: COl'NTY, FLOitIDA:
This is my declaration of Domicile :red Citizenship in the State of Florida that I am filing this day in acconiancti
and in contorntity with (.^.ia~ter 221, Section 222.17, Florida Statutes.
Colt.unbus
I :~~as formerly a legal resident of-------- --- -
(City]
and 1 resided at _' 7'.'~U L~ ~'dS -'O? a - -- ----- _-
[Street and Numbed
to and a•n and ha:-e been a bona fide resident of the State of F'1^rida since
_ ~t11C1 --
State
_. Ifo~ce:•er, i have changed my domicile
_ 1 -___ __. day of
3heric3~r. Lane
(Street End Number]
t `'
_- l.h,u S-__ - _ .___ -. 19- ~ and I reside at
~.drn
'+'ORT PIERCE, SAINT LUCIE COUNTY, FLORIDA,
ar.d this statement is to be taken as my declaration of citizenship, actual legal residence an i domicile in the State of Florida.
jInsert here any pertinent farts. such as sal° of property or business, or relinquishment of employment
at formes domicile, rerno: al of family to new dorm ~~i'.c purchase of home, etc ]
L~~. biisi_iI><; .res~uer.c;;
FLIED AND RECORDED
IN_~p~.i~cial-I~:~~.L~+-_ 9GOK .. ,
1462 NGV -2 AM 9:53 :: ~~ ~ ,
._~ .
ROGER P017RAS,CLERK ~~~~'' -
ST. LUCIE COIi`aT'i, FLORIOA ;~ ~~~ ' ~ -
,.
,~ I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and comely
:with a]~ ot}rJJer mgllit:ements of a legal resident of this State.
~j;'f,2~'C;P.TFIF~!CEItTIFY that I have no i^tention to return to my former domicile, and I intend fo remain in
FOR'f'~1?.I)Ft~E, ~,wIN'I' LUCIE COUNTY, FLORIDA, permanently
. ~ . c s cc ~ l~~'/~.- ref C
. i `>
' ~~ ~ lire L. nu fete] ~-_
l .... / "~
i - =
v l [Address
,~ Jere ~. ~;u~e~3e
Sv:orn to and subscribed before tree this- `'- _-3ay of - rtOVP. as_-__ ____, 19-ti2
P.OC;I-f? POITRAS ------ - - ------ -------- --- ------ - --
('LI:Py: CiRC1:1T Cc~li.;1' Notary Public
//!
3y - ~ L_~1 ~'~~~_-_ -_-- ---- D.C. 11y Commission expires --_ _ --
[To be executed in duplicate and orfgin3l tiled sith Clerk C?rcuit Court, and duplicate with Tax Assessor]