HomeMy WebLinkAbout2055 Declaration ot Domi~iie and Citiaenship
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i0 THE S?A[E AND COUNTY TAX A5SE55C~i~,
~UC.IE COUNTY, FIGRIDA
;~us ~»y c~ec~aration ot L`o~~~~uic and C~hzensh~p in the Staie of Fior~da that I ain fil~ng t~iis day in accordance and
~n conform~ty w~th Chapter 222, Sect~on 222.17, Fiorida ~tatutes
I•.vas formerly a legal residerit of ChesterfYeld _ Massac.~use~ts
(City) (State)
Gene r31. '~eliver~
and I resi~-ied at However ! have changed my domiCile
;Street and Number)
tc~ and ar7~ and have been a bona fide resident of the State of Florida since 1~ day of
Sept~nber 5~ 3t~27 Byron Street
, 19 _ ~nd I reside at - - - -
(Street and Number)
FORT PIERCE, SA{NT LUCIE COUNTY, FLORIDA
and this statement is to be taken as rny declarat~on of citizenship, actuai legal residence and domicile in the State of Florida.
(lnsert here any pertinent facts, such as sale of prope~ iy or business, or rei~nquishment of employmenT
at former domicile, removal of family to new domici!e, purchase of home, etc.)
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-r~I
~L. REC RDED
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~ Esta~lishi~g residence '65 j.~o~~ 5 a~~ ~l~ E,~
~ 9 : z6
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j . !=~OR1D~ ~ Y.
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I FUkTHER CER7IFY that I will comply with all other requirements of a legal resident of this State.
i FURTHER CtRTlFY that I have ro intent~on to retum to my former ~omi~ile, anci i intend to remain in FORT
FIERCE, SAINT LU~IE COUNTY, FLORIDA, per~ranent!y.
\ x~ . \ _ ~t. 'v__r_--- -
. - . . . (Name)
~ ~ W~.lliam 3ak er
(Address)
' 9'worn 1o and subscribed bEfore me this day of _ x0YQ71ber ~ G 65
ROGER POITRA5 - -
CLERK CIR IT COURT Notary Pub!ic
u_~'
BY a-L---- - ~.L.~C~. _ D.C- My Commis;ion expires ,
(to be executed in ciuplicate and originai filed w+ih Clerk Circuit Court, and duplicate with Tax Asaess~er.)
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