HomeMy WebLinkAbout2149 Declarati~?n of Dart~iciie and Citizer~ship '9
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TO THE JTATE AND CrJUN i Y TAX A55E5SOR,
51 LUCIE COUNTY, fLORIDA
This ~s my declarah~n of Uor•~~~~Ie ar,d C~t~zensh~p in the State of Florida that i am filmg this day in accordance and
~n conformity w~th Cha~ter 222, Secf~on 222 17, Florida Statutes
I was formerly a legal resident of La~ter _H8SS8Cl'lua@tr~S
(City} (State)
210 ProspeCt Street
and I resided at . How•ever I have changed my domi~ile
(Street and Nu~Yiber)
to and am and have been a bona fide reside~t of the State of Fiorida since ~ day of
OCtober , ~9_ b5and I reside dr . 109 Camino Street~Port St...__L~~~ . ,
(Street and Number)
FORT PIERCE, SAINT lUC1E COUNTY, FLORIDA
and this statemen! is to be taken as my declaration of citizenship, actual legal residence and dnmicile in ihe State of Florida.
(Insert here any pzrtinent facts, such as sale o` property or business, or relinquishment of employment
at former domicile, remova! of family to ne~v domicile, purchase of home, etc.)
Establishing residence
~ILE •NG REC~,~ ~OK
~ ~ic~a~ R~ecv~~
C ~
f,~~_r ~ ~ ~ : 20
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~ ::~.~r~K
f~ • ~;JU~~~TY.
~T , FL.OR~D~~
.
( FURTHER C~RTIFY that I will comply with all other requirements of a legal resident of tttis~5t~To~:'•`:.'•••'~.
! FURTHER CERTIFY that i have no intention to return to my formnr dorni~ife, and I intend to remain in FORT
PIERCE, SAIN7 LUCIE COUNTY, FLORIDA, p2rmanently.
-
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~~'~f `u`"'-~`---~ --E°'~
" • (Name)
- Edwa~r d L. Bak er
~ - ~ ' (Address)
. 1 „
~ '
~ '$worn to and subscribed before me th~s _ 8__ day of _ November ~ 9 (>5
ROGER POITRAS - - - - - -
CLERK CU1T COURT Notary Public
~ _ D.C. M Commission ex ires _
BY - -Sil • . _ Y P
(To be ex~cuted in duplicate and criginal filed with Clerk Circuit ~ourt, and duplicate with Tax Assessor.)
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