HomeMy WebLinkAbout1603 . _ ~
' DaNcl~ration oi Domlclie and Citizenship
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TO THE 5TATE AND COUNTY TAX ASSESSOR,
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~3•, 5~; ~
Sl. IUCIE COUNTY, FLORI~A:
This is my declaration ~f Domic;le and Citizenship in the State of Florida that I am filing this day in actordance and
in conformity with Chapter ~22, Section 222.17, Florida Statutes.
I was formerly a legal resident of Yp~~l~~_-- - I~L~Ch1$~4 -
(Ciy) (5tate)
Red I.~if I.BII@ However I have changed my domic.ile
and I resicfed at - - - .
(Street and Number)
to and am and have ~en a bona fide resident of the State of Florida since lst__.. day of
June 19~b5 and I reside at _ 1514 C1tTUS AVe•
- (Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statem~nt is to be taken as my declaration of citizenship, actual lega! resiclence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, o~ relinquishment of employment
at former domieiie, removal of family to new ~omitife, purchase of home, ett.)
F!l.EQ~ND RECO
• R~EO
~ntering child in school 0~
~~OK
'6S ~ ~ t~; 2 7 p~~l I
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a`,... R~S c f; i=;:~;
. , ~ t~UC~~~~G' ~LERK
_ w.'.~ . I~ - FLORIpqUNTY.
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I FURTHER CERTIFY that I will camply with all other requirements of a legal resident of this Staie.
I FURTHER CERTIFY that I havs no insention to return to my former dorniCile, and I intend to remain in FQRT
PIERCE, SAl1~P~ ~.UCI~ COUNTY, FLORIDA, permanently.
h'i ~ r
• • '
' ~ . ~ ~ (Name)
. ' . : . Patric ia Neel~
~ . . , : ~ ~ ` (Address)
. .
Sworn tn and subscribed before me this Z~tb day of Au~uSt ~ ~q 65_.
ROGER POlTRAS - - -
~ltK ~IRCUiT COURT Notary Public
-
gq- _ - D.C. M~~ Commission Expires
(To !~s sxacuted in duplicate and original ~iled wjthR Clerk Circuit Court, and duplicaN witrh Tsx Ass~ssoo~.)
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