HomeMy WebLinkAbout0096 ~
• Decla~ation ot Domicile and Citisenship ~:j
TO THE STATE AND COUNTY TAX ASSESSOR, l223
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ST, lUC1E GOUNTY, FIORIDA: ~
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This is my decleration of Oomicile and Ctize~ship in ths State of Florida that 1 am filing this day in acoordancs and • a~
in aonformity with Chapter 222, Sectior? 222.17, Florida Statutes. '`i'~
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west Lebanon Nea IIampshire
1 was formerly a legal ~esident of -
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snd 1 rosided at . However 1 have changed my domicile
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to and am and have been a bona fide resident of the State of Florida since 8 day of
fgnnArv , 19__~, and I reside at 314 OoeBII ~T~~9 ~
(Street and Number) f~~-
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~ORT ~IERCE, SAINT WCIE COUNTY, RORIDA
~nd this statement is to be taken as my decla~ation of citizenship, actual Icgal residence and domicile in the State of Horida. • tiF
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(Insert here any peninent facts, such as sale of property or busineu, or relinquishment of empfoyrr~nt
at former domicile, removal of family to new domicile, purchase of home, etcJ ~ Yl
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duerdian mo~ing lrom 66 Tatt s~enue, ~lihite RiTer Junction, Yermont
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1223'?'9
Entering in Darlene Fisher in sohool ~y;~
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~ 1 EURTHER CER'TIFY that I will register at my local address when the reg~strot~on books're~pec~'"~~~OmQly`wi~h
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all other rtquirements of s legal resident of this State. • 1
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1 FURTHER CERTIFY that I have no intention to retum to my former domic~le, and I intend to~ remain in FORT ' i
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PIER~E, SAINT WCIE COUNTY, FLORIDA, permanently.
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'z.i;~'-~ _ ".~:=•r~`°r, . 16 Jenuery 64 -
i ~i~?'oC~t! i~u6scribed before me this day of 19 .
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; ROGER POITRAS ' -
~ ~LERK CIRCU CO Notary Public
LERK
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gy ' D.C. My Commiuion expires
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~ Re b~ ~aneuhd in duplieaN and ai~insl filed witl~ deelc prevh Cour~, snd duplie~t~ with Tax Assessor.)
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