HomeMy WebLinkAbout2775 Deciaratlorr mt Domicile and Citizenship
~ : ti r_
~ i t l_ f t
TO THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FIORIDA:
This is my declaration af Domicile and Citizenship in the State of Florida that I am tiling this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
~ was for~nerly a lega! resident of ~a~~Z'OOt'Ck _ N~~S! ~QI.ti
- - (City) (State)
and I resided at S1S HS1Stcad Ay@.~__ _ Wowever I have changed my domic,ile
(SYreet and Number)
to and am and have been a bona fide resident of the State of Florida since 2nd day of
- JUly 19_6S and I reside at 742_ B.~3~~CL
(St eet and Number)
FORT PIERCE, SAINT WCIE C~UNTY, FLORIDA
and this statement is to be taken as my ~eclaratian of citizenship, actu~l legal residence and dornicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purthase of home, etc.)
Bstablishing residency
wi11 enter children in school in the Fall
. - ~.o ~ECOR g~~K
~ F1L . • ~
~ ' ~ ~ `u ti ~ `l l f?9'` ~
l 4 , 1 Cir~iV`~' , e '1
. ~ , 3
, :`w ~r~~ . t>~ ,~5 ,~t.. ~{y,....,~,~~~
_ - ~ ~a CLER~ .
` ; ~ . . w`:,,
~ ~u ~Y.
~~G~'~: ` ~1~ ~ N
5~. ~~~RIDA
W ;
I FURTHER CERTIFY that I will comply with all oiher requirements of a legal resident of this State.
I~URTHER CERTIFY that I have no intention to return to my forrner dorr.iSile, and I intend ta remain in FORT
PIERCE, SAIN7 LUC1E COUNTY, FLORIDA; ~ermanentiy.
~ ~ _C~ -G~l(~_
- ~
((Vame)
Patricia Mc Wade
~ ~
' 1~~ ~ _
~ (Address)
. ' J i J ' . , , ~
' , : : • - 14th Ju1y t9-fi5
:'_5wcrn,•fv~a`r~d subscribed b~fore me this _ . _ _ _ day of
! ir~,'
~ ~ ~ ~~GER POITRAS
K CfRCU1T CO RT Natary Public
mmi ion ex ires -
D.C. My Co ss p
(To be exacuted in d~plicate and original filed with Clerk Cireuit Court, and dupliute with Tax Assessor.)
~J~~ 12~ ~