HomeMy WebLinkAbout1609 Daclaration of Domicfie ~nd Citizenship
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TO THE STATE AND COUNTY TAX AS,SESSpR,
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51. LUCIE COUNTY, FLORIDA:
This is my d~tlaration of Domicile and Citizenship in the State of Florida that I em filing ihis day in actordente ar?d
in conformity with Chapter 222, Section 222.17, Florida Siatutes.
I was form~rly a legal resident of _.B~1Z~s Tt7~iS
tCiry) ~ (State) ~
200 Ridge~rest
and I. resided at _ - - _ - ~ _ _ . Wowever I have change~d my domiGile
(Street and Number)
b end am and have been a bona fide resident of the State of Florida since 26_ day of
Augnst bS 122 Yacht View L~ne
19~-- , and I reside at
(Street and Number)
IrORT MERCE, SAINT tUCIE COUNTY, fIORlDA
and this statement is to be taken as my declarat~on of citizenship, actual legal rssidence and domicile in the State of Florida.
(Insert h~re any pertinent facts, such as sale of property or business, or relinquishment of employment
at former dom~cile, removal of family to new domicile, purchase of home, etc.)
Er~tering children in Fort Pier~ce B1e~entar~r
Son and daugkter
~IL yQ ~C8 ~E@
~ tfl! 8 0 0 K
~ . _ a+r~..G.~e1'.~.
• . . '65 ~ 2 7 P~q 12 : 2 2
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P. ' ' _ ROiit~{~ 'r':;. , ,~:`,S. ~~LRK ~
~ ..~••r.• E" S~, ~.UCtC COUNTY,
~ ~ G~; FLORtDA
I~URTHER CERTIFY that I will comply with all other requirements of a legal resid~nt of this State.
t FURTHER CERTIFY that I have no intenfion t~ return to my former domit~le, and I intend to remain ir~ FOaT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanentfy.
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(Nam .1' ~ L~
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Betiy Clark ~ `~~?r+~`~
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Swom to and subscribed before me fhis day of ~ b~
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RO~'sER POITRAS __~/~~~(`T,~-..- `
CIERK ClRCUIY COURY Notary Put~ lic
~1? h6~ic. Stats o} Horid~ it tarqe
~Y - D.C. M,y Commission expire~ E ns Qrt- 3(!. 1465
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(Ta b+~ ~xecuted in d~plicste and originai ~Isd with Ck?k Ci~cuit Cov~t, and duplicrts with Tax As~ssor,j
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