HomeMy WebLinkAbout1551 - - ~
$
Daclaration of DomiCile a~d Citizenship =t ~ j -
TO THE StATE AND COUNTY TAX ASSESSOR,
51. WCIE COUNTY, FLORID.4:
This is my declaration of Dom~cile and Citizenship in the State of Florida that I am filing this day in accordance and
in tonfarmity with Chapter 222, Section 222.17, Ftorida 5tatutes.
I was formerly a let~zl resident of CH,~~~iTQ~. - - - - W~ - - - '
(Ciry) (State)
214 Hickory Rd.
and I resided at . . _ - - . Wowever 1 have changed my domiCile
(Street and Number)
to and am and have been a bona fide resident of the State of Flarida since lst day of
. June ~S 2301 Bli~abeth ~ve. ~
- - 19-- - , and I reside at -
(Street and Number)
l~ORT PIERCE, SAtN1~ LUCIE COUNTY, FIORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residente and domicile in the State of Florida.
!Insert here any pertinent facts, such as sale of property or bus~ness, or relinquishment of employment ~
at former domicile, removal of family to new domicile, purchase of home, etc.)
ENTBRING TM~O (2) CHILDRBN IN PUBLIC SCHOOL ~
IKAR]C A. liIORLBY ( 7 qr s)
T IM~THY A. WiORi.~Y ( 6 qrs )
~:+~i• ,
.•.,C J ~+un-,
: ~
FI A REC~R~Ed ~ ; .
• ~ , C~.
~N ~Ot7K •
.s ~ f l ~ ,
` ~ ~ • ~J ~`r~ . . ~
• ~ - r
~ ~ . /n ,ra r ' i
'65 AUG Z 6 AM I I ' I 9 - : ~S <; '
F 4~l1~1(~ i`' ~ ~ I l~ . !
~_l...~1_~ti.A~,-~- ~ `
- CLERK ~ ~~.,v• E
f~OGE~ i'vi t r,i~S t
ST. ~UCIE GOUNTY.
FLORIDA ~
i FURTHER CERTIFY that I will compiy with all oiher requirements of a legal resident of this State.
~
F
I~UftTHER CERTIFY that I have no intention to return to my former domi~ile, and I intenc! to remain in F(~RT ~
~
PIERCE, 5AIN7 LUCIE COUNTY, FLORIDA, permanently.
~
~ ~
~
. (Name) ~
, . .
J ` • , . !
'
U ~ , ~ ~ - S a r ~h J . MI+o r 1e i
~ : - ~ • - (Address) ' ~
~ - . ~
; , .
~ ~ . ~ ~y ~
j ~
~ ti ' . ~ , :
• ~ '
r--- ' ~ 26th
•.~,,.,~yvOi~n~ o,and subscrioed before me this ~ day of ~11$11.5~~__. , 14!fl~~• ~
~ n ~ r f,`3 .
'
~ ~ , . . • , ~
ICOGER POITRAS - I
CLEItK CIRG COURT Notary Public ~
gy ` _ p.C. My ~ommission expires . l
~
(To b~ ex~cuted in duplicate and originaOl fi~'led with Cierk ~ircvit Cour~, and dupliute with Tax Ass~ssor.) I
a~~~1~5 ~49