HomeMy WebLinkAbout1095 ~ r
0?eclaration of Domi~ils and Citizensh~p .4.3c31~51%
TO TH~ STATE AND COUNIY TAX ASSES50R,
Sl. LUCIE COUNTY, FIORIQA: ~
1'his is my decla~ation of Domicile and Citizenship in the S!ate of Florida that 1 am filing this day +n accordance and
in conformity with Chapter 22?, Section 222.17, Flor;da StatutGS. ,
I was formerly a legal r.esident of N~~~~$ _ T~NN !
(C~ry) . (5tate)
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and 1 resided at _ _ ~S~ _ _18th _ A~! . $OUt~ _ . However I have changed my domi~ile ~
f5treet and Number) ~
to ar?.~ am and have been a bona fide resident of the State of Florida sinte _.__.9th day of =
Augast 6S 109 Roalyn A~e.
- - 19---- and t reside at
(Street and Numbery ~
,
t~!!tT PI~RCE, SAINT LUCIE CQUNTY, FLORiDA
and t'rtis statement is to be taken as my declaration of citizenship, actua! legal residence and damicile in the State of Floricia.
(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, purchase of home, etc.) ~
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,BSTABLISHING RESIDBNCB ~
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t~~L . ANO RECORaE~ -
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~ : ~ITF~A~. C~ERI(
~`:._.•f ~ S?'. LUCIE COUNTY
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! FURTHER CHtTIFY that 1 will comply with all other requirements af a lega( residenf of this State.
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! FURTHER CER71F`f that I have no intention to return to my former domi~ile, and I intend to rernain in FOR7
PIERCE, SAINT LUCiE COUNTY, fLOR;DA, permanently. !
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' _ . '~ti ` MlAKDA D. THEODOR.B .
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`r : ' 13th Au nst 65 ~
Sworri'to and subscribed before me this - day of , 19
I
RQGER POITRAS _ _ . _ i
CLERK CtRC COtIRi' ~ Notary Public ~ ~
8y , _ v.C. My Commission expires '
(To bs ~x+rcuted in duplica~e snd original ~iled with Clerk Circvit Govrt, snd duplicate with Tax Asssssor.) i
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