HomeMy WebLinkAbout2209 Decf~ration af Domicile and ~Itlze~shi~
TO THE STATE ANU COUNTY TAX ASSESSOR,
~ ~i~~~_t
Sl . LUCIE COUNTY, ~ LORIbA
This is my declaration of Dorn,cile and Citizenship in the State of Florida that I am filing th~s day in atcordance and
in contormity with Chapter 222, Section 22?.17, Florida Statutes
I was forrr~erly a lega! res~dent of N~W Y02~C _ I~Biii 1'02.'~_ _
(Cityl (STate)
and I resided ~aert~n Street Forrest n1115 However I have chanc~ed my domi~ile
(Street and Number)
to and am and have been a bona fide resident of the State o~ Florida since 17~h day of
- - ~?I`l~ . 1 , and I reside at 10a ~18,~IbT'~ - -
(5treet and N~~mber}
fORT Pt6RCE, SAiNY tUCiE COUNTY, FLOi21DA
anci this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in ihe State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domitile, removal of family to n?w domicile, purchase of home, ett.}
Esta~lishing residenae
~i~..~o r~NG RECORDED
, ' U~K'.1~- ~~6~A~--~ 0 0 K
.
. '65 t~~'! 9 P~d 2: 4 6
- ~ ir~_4~i):~1.
~ - - . . ~cOC=- I~. , . cr.K
- ~ S~'. ~LUC1E C~JU~~7Y,
, ~ . , F~ORIDA
I FURTHcR CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTNER CER7IFY thar ! have no intentien to return to my former domi~ile, and I intend to remain in FOR7
PIERC~, SAtNT LUCIE COUNTY, FLORID.A, permanently.
. . . . ~ ` l 6!'t~~r.~-~~ _ 4;~.,--. ~"(~-,~-i
~ ~ - - - . • : ~`~Jac ueG~ a ~~a~rail H~
Q er
. ~ ~ - - -
. Kathild8 (Addr~seer
Sworn to and s~bscribed before me this _ __~h__._ _ day of NOV~mber _ 19 O~
ROGER P~ITRAS - - -
K CIRCUIT COURT Notary Public
~
~ - ``-"~r..~--___- ~'-~~Y-~~~-----_ Q.C. My Commission expires
(To be ~sxetuted in duplicate and ariginal filed with Clerk Circuit Court, and duplicste with T~x IAssessor,)
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