HomeMy WebLinkAbout2257 _ . " _ . 9~
Declarat:on ot Domicile and Citizenship ~ ~
TO THE 51ATE AND COUNTY TAX ASSES.SOR,
.19~t)1~`~
51. LUCiE COUNTY, FLORIDA:
This is my declaration af Domicile and Citizenship in the State of Florida that 1 am filing th;s day in accardance and
in cnnformity with Chapter 222, Section 222.17, Flor+da Statutes.
I was formerly a legal resident of . 8~1~'d~_ x~~~_W_.__~___ _
(C i ry) (State)
and I resided at _ _STb T~1dlb!`OOk FOd However I heve changc~ my damiCite
(Sireet and Number)
to and am and have been a bona fide resident of the State of Florida since _ l~h _ day of
pctobar -
_ _ . , 19_6~ _ ; and I reside at 2- ~_~6~~kgl/~od Par1[
(Street and Number)
FORl' PIERCE, SAlNT tUCIE COUWI'Y, FLOAIDA .
and this statement is tn be taken as my declaration of titizenship, actual legal residence and damicile in the SPaPe of Flarida.
(tnsert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, ett.)
Sstabli~hing reaidence
. " FIL~} AN R p~p EG
- ~ . , , . ~ ~,11'~tCIS~ K~~ ? t? 0 K
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. . ST.1tt~U~fE ~OU~~.TY,
' FLORfDA
I FURTHER CERTIFY that ! wil! comp(y with ali other requirements of a legaf resident of this State.
1 FURTHER CERTIFY that I have no intertion to return to my former domi4ile, and ! intend to remain in FOR7
PIERCE, SAlNT ~,4,~CIE COUNTY, FLORlDA, permanently.
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- . ' - - . dohn E, Jo (tva ) I
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. . ~ g~her K (Address)
Sworn to an~ subscribed before me this day of _~~~b~ i9~
ROGER POtTRAS _ _ _ '
, RK CltttUiT URT Notary Public
C~~ J~P 4~-t- .~C-u'L~---
8y _ D.C. My Commission axpires _
(To bw sxscut~d in duplicate and origina) filsd with Clerk Circuit Cou~t, and duplicats with Tax Ass~stor.)
~OOK 1~30 45b
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