HomeMy WebLinkAbout0217
E
y j
Declaration ot Don~icile and Citizenship
,
,
I -
TO THE STATE AND COUNTY TAX ASSESSOR, ~1~64
ST. LUCIE GOUNTY, FLORI~A: ~
~ w' '
This is my declaration of Oomicile a~d Citizenihip in the State of Florida that I am filinq this day in aooordanoe snd
;n oonfamiy with Chapter 22~, Sectio~ 4Z2.17, Florida Statutes.
' !
t was formerly a legal rosident of ~~s CitT - t~:'s ~
Kity) (Sta») ;
R~ }
~ "Y.
and 1~idad et E. 1SOth TerraOA . However I have chanyed my domkile -
~
(Sttaet and Number) ~ ~
~ . >
ro and sm and hsve been a bona fide resident of the State of Florida sinos 1 day of
1
sugust 7Z0 30 BSrd street :
, 19 and i res'ide at TM~ and Numbsr)
~
_ :
i; FORT M~CE. SAINT WCIE COUNTY, RORIDA -
j+ .
i
~ 1 and this statement is to be taken as my declaratwn of citizer?ship, actual legal residenos and domidle in ths Stete of Horida.
I i " i~,:r
' 1 (Insert here any pe~tinent facfs, such as sale of propsrty or business, or relinquishment of employment -
; , .
~ et former domicile, removal of family ro new domicile, purchase of homs, etc.) _
~
i . , ~i
~ ~
' ' ' Ilppifing !or hoaeatead `
12~464 ~
. L: Fl~~
:.,,~,i~~~;,r , iN , RECp~p,~-p ~ .
` ~Q , a..~S~
. ~ 4 "f.':
p . ~ V
~ ~-.s~v~~1 f~ ~OOK X°
. : , , i, ;
: - - r9s~ ~u1~ z .j..
, o : 0 py t
~ 12, ~s
• ROC 0
.~..•v-•. G:,~ f
,•~i . ° ER
, ~a i~.~~*;.~;~''~ - St. [UC1E C0~
~RAS, CLE~ . -
~ , T)', F ~pA
= 4~ OR ; ~
i . _ U;~;~E.C~.. . ~ ~
. ,
;
~ ; _
; .
~ .
- . ~
,
~
i -
{ ~ I FURTHER CERTIFlf that 1 will register at my local address whsn ths rogistraNon books reopen, and abmply with
t `
all other roquirements of a legal ~esident of this StaM. ''r
3 i~ _
~ I FURTHER CERTIFY thst I have no intention to mtum to m~? farmer domiqle, and I intend to remain in FORT °
,
,
WERCE, SJ11NT LUCIE COUNTY, FLORIDA, permanently. -
W
~
(Name) ~
, Y~l'rAu I+OL~ : ~
• (Address)
~r
1oII11t ~ 64
- Sworn to and wbsuibsd befor~ me this day of - 19
. . • ~ r,,,,: . t
0.;:
~ae rort~?: ~'uEYr~?b:~: r-
e .
- + ,
qRCtltT ;ca; ~r''~j '.~tary Publk . K
• 1~:.:_., .f
r ~lU
4-?~-ICI~ D C. 7 i~ lllly=CqiMirif~sfi~1 ixpires . .
y~?,~~~"~' ;
~ a ~ R' 7g ~
~ti e~: ~ . r~cc 2~7
(Te M~oc~cvhd in dupikah and ai~inal Al~d wilb Cl~ek Ci .ro~i1, Carr~; and duplkah with Tax Ass~er.I
- : .