HomeMy WebLinkAbout2109Dtc~~iration of Qamicile and Citizenship
~~RK ~2 `,~~ 45
TO THE STATE AND COUNTY TAX Aa~31:SSC>R. .
5T: LUCIE COUNTY, FLORIDA: ; T . (_ ~ ~~ . ( ` . ~ , ~: - r ~ ~ A .
This is my declaration of Dom]cilR sad Citizenship in.the State of Florida that I am tiling thL day in accordance
and in conformity with Chapter xd2, Section 22'2.1?, Florida Statutes.
Missouri
I was formerly n legal resident o.t '[City] State
and I resided at ~• ~x0 Dri t3 `~Yhitstnzll Air Fore ~$41owever, I have changed my dom!clle
[Street and Number]
~ and sin and have been a bona fide resident of We State of Fio:ida since 4' day of
' December
North Beach
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA,
Is_~ ana I reside at 2413 T~m~rind Drive
[Street and N-imber]
and this statement is to be taken as my declaration of citizenship, actual legal residence an9 domicile in the State of Florida.
[Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, remo~•al of family to new domicile. purchase of home, etc•J
Establishir>{3 residency
netiring fromthe air FArae
...,,
. ~~;~~.curT;•, .
f•• ':~ CJ
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1~.1.1.9f
FI A~~((D RECO DED
5~urt
196 DE'C 14 GM I I: A9
ROGER POITRA5, CIfRK
ST. IUCiE COUN1'f, FLORIDA ~~''
r~
I FURTHER CERTIFY that I will register at my local address when the registration b=olca reopen, and comply
with all other requirements of a legal resident of this State.
I Fi)RTIiER CERTIFY that I have no intention to ref+~*n •to my former domicile, and I intend to remain in
FORT PIERCE, SAINT LTJCIE COUNTY, FLORIDA, permanently.
•: ~:.} ~ T:: ~••: E
~,;•;....r D Wald , Re ha;., L'l. Co1,UiaF RAt,
,il:~',~ftti, ~
i _
`~°'4~to an+d guUe2~~l;ed•before me this_ jay of
r.; . .. s
~,'~~+~1',..P
` ,~r•~.Ci{~~%~RCUIT COURT
- (Address]
December _ _ Is ~
Notary Public
,y _ ~-v7i~ - D.C. ify Commission expires
[To ba exocuted in duptlcato and origilesl filed with Clerk Ctrcult Conn, and dupiicate with Tax Assessor]