HomeMy WebLinkAbout0280 .i_~c~3~~~ v
Declaration at Domicile a~d Citizenship
rt0 THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUN1'Y, FLORIDA~
7his is my deciaration of Domicile and Citizenship in ihe State of Flo~ida that I am filing this d~y in accordante and
in confarmity with Ch~pter 222, Section 222.17, Florida ~tatutes.
I was formerly a legel resident of _ _ ____.___.-~Q-----------
(City) (State)
1Sq7~ Nelacreat Rd. However I have chan ed m domiCile
and I resided at - - _ - - _ _ . g Y
(Street and Number}
to and am and have been a bona fide resident of the State oi Florida since 5~ day of
October 6~ 10$ Plac~ta G~t.
- - _ _ , 19_. . , and I reside at
- - _ - - _
(Street and Number)
FORT P{ERCE, SAINT LUCIE COUNTY, F`ORIDA
and this statement is to be taken as my declaratian of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of preperty or business, or relinquishment of employment
at former domicile, removal of tamily to new domicile, purchase of nome, etc.)
F`iling fan c~anestead purpo~es - -
~~'VD RECORDED
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,65 i;,,~~i~ 9 . 2 0 . ' ~y.
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. FLO~IDA . ~
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I FURTHER CERTlFY that I will comply with all other requiremen's of a lega! resident af this Siate.
I FUR7HER CERTIFY that I have no intention to return to my former domic,ile, ar,d I intend to remain in FORT
PIERCE, SAINT LlJCIE COUNTY, ~LORIDA, permanently.
~
~ (Name)
• _ . , ~ X~ Wil].ard H. Gvodman
. ,
~ = , ~ _ ~ ' (Address) -
':.'~~16~o~r~ to and subscribed before me this 1~ day of N~V~lb6T' _ 19~
ROGER POIT
CLER!( IRCUIT OURT Notary Public
~
By _ D.C. My Cammission expires -
{To be executed in duplicate and ariginal filed with Clerk Cirtuit Court, s~d dupticate wit6~ Tax Assessor.)
BOOK~31 _ 274 ~
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