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DeClaratlon at Domicile and Citizenship
TO YHE 5TATE AND COUNTY TAX ASSESSC)R,
51. lllClE COUNTY, FLORtDA: i3L?~~+
U
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordante ant~
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of ~~18I1t8 _ _G@0~~8
(C+ty) {State)
and I resided at _ 42'~3 gutC}1fIIl~ dY'iV@ . However I have changed my domiCile
(Street and Number}
b and am and have been a bona fide resident of the State af Florida since 17th dey of
_.'~uguat. ~9__ 6~ and I reside at801`__No]~`_th__4th street
(Stree4 and Number)
FORY PJERCE, SAtNT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual lega) residence and domicile in the State of ~lorida.
(Insert here any pertinent facts, wch as sale of properTy or business, or relinquishment of employmeni
at former damicile, removal of family to new domicile, purchase of home, etc.)
Entering child inschool
, ~Il ~
QN EC RDED
~`~DOK
. .
'~5 ~!rn ~ ~ ~
~ ~ ~j ~ . r ~ ~ :J : 3 C
- ~~~~-,w-"~~ . ~ ROi~,~.~3f343~
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; V.~. LL~ ~C K
- ~ ~ • : ~ 1 C t~
" " ~ . FLORtDa ,`VTY,
. ;~•,...••cc..~ .
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I FURI'HER CERTIFY that ! will comply with all other requirements of a lega( resident of this Stat~.
I FURTHER CERTIFY that I have no intention to reiurn to my former domiSile, and I intend to remain in FORT
PIERCE, 5AlNT LUGE COtJNTY, FLC?RI~A, permanently.
~ . . . ' _h _ _ ~ ~ v/3 /
~ • • ' . (Name)
~ Ine~ Weaver
~ - . . . ~ - -
. , ' ~ (Address)
, . ~
.,.:~.t~
• , 5~
Sworn 4o and subscribed before me thi, day of ~uguS~ , 1~~j
ROGER POitRAS _
tEitK CfRCU1T OtJRT Notary Public
~-~-~t~~.. ~
8Y D.C. My Commissian expires ~
(To be executed in duplicate an~{ original tiled witfi Clerk Circuit Court, an~i duplicata with T~x Assessor.)
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