HomeMy WebLinkAbout0205Declaration of Domicile and Citizenship
9. 4.
TO TILE STATE AND COUNTY TAN ASSESSOR, 80~K ~ f 1 PACE ~~~
S'f. LUCI)•: COUNTY, FLORIDE : ~•- `7
~T• ~,iClC ~.,UNTI', FCA.
This is my declaration o1 Domicile and Citizenship in the State of Florida thnt i am"ttittlg this day irr accordance
and in confcrmity with ChaptEr 222, Section 723.17, Florida Statutes.
.1rli ten
I was formerly n legal resident of- -- -- Il ---- _ y~r;lrii9 __
[City] State
S31 23 Street,u~
and I resided at _ --- -~-_____. However, I have changed my domicile
[Street and Number]
to and am and have been a bona fide resident of the State of Florida since ___20 ___ _ day of
~. ~
--- ~r 11 ---• 19 8~' , and I reside at - - j4411~L_-f _ ~uX "~:Z~-~-r- -
' [Street and Numberl
1•'ortr'i arc e ~lv:: , L;:, ker.ood r~ rk
40RT PIERCE, SAINT LUCIE COUNTY, FLORIDA,
ar.d this statement is tc be taken as my declaration of citizer_ship actua: legai residence an l domicile in the State of Florida.
[insert here any pertinent fact, such as sale of proi»rty or business, or relinquishment of employment
at former domicile, removal of family to ne~•; domicile purchase of home, ete•)
L:=i.~:U11Sl:ii1~; ii,C;i.ic:6L'Cy
Fl D A(~D IZECORDE()~?~~
Ih[~ DOK '~
19F11VGV -2 AM !0: 2p ~ •
ROGER PGITRAS, CLERK ~~ •• 1
Si. LUCIE GOUNI~, FLORIDA) ~ ..
/~~~C~
I FURTHER CERTIFY that I will roister of my local address when the registrntic~n woks reo~~en, and comply
with all other regcirements of a legal resident of this State.
I Fi;RTfII•:P. CF.RTIE'Y that I have no ir.tenlion to return io my former domicile. and I intend to rcnain in
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~7 J
~- ~~
_. y ~ • ~ ~ v ~": s. Planche PeGrce
. ,- -- - --
• o'• _ .`' (Address] --
Stvnr~ to srrid"~;ubsc~iDed before me this jay of ~____-_______-___ _-___________ 19_-___ b2
ROrf:R I'OITP..1S
CLF.f;i: C'II:;'C1T ('C)L'.TtT tiotary Public
3y __ _-~~~- _~~L~~~ ______- _--- P,C. \I. Commission e~nires ____ - __--
[To be executed in duplicate and original file ~ n-itl- Clerk Cirrrrit Court, and duplicate with Tas Assessor]
11