HomeMy WebLinkAbout0613 Declaration ot Domicile and Citizenship
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t0 THE SiATE AND COUNTY TAX ASSESSOh,
51 LUCIF COUNTY, FLORIDA
This ~s my deciarat~on of Donuc,le and Cihzenship i~ the State of Florida that I am filing ihis day in accord~+nce and
m conformity vvith Chapter 222, Sect;on 222.17, Florida Statutes
I was forrr~erly a le9ai resident ot A~rid~~~n~~ North_ ~'_OI.~.T1a
(Ciry1 (State)
and i resided at 3~0 ~ 2nd Ave rue However 1 have thanged my domiCile
~St;eet a~~d Number)
n
to and am and have beer, a bona fide resident of the State of fiorida sirce _ _ day of
Noveaaaber 6~ 364b O~ndex Avenue
19._ , and I reside at - -
~ (Street and humber}
FORT PiERCE, SAINT LUCIE COUNtY, FLOCtIDA
and this statement is to be taken as my dectaraticn of citizenship, actual legal residence and domicile in the S1ate of Florida.
(Inseri nere any pertinent facts, such as sale of ~roperty or business, or relinquishment of employment
at former domicile, removai ot family to ne~n,- domicile, purchase of home, etc.)
Entering 1a~azda F1lison i.n 6~h ~rade ,F~~~p
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I FURTHER CERTIFY that I wil! comply with all other requirements of a iegal residert of this State.
I FURTHER C~RTIFY that I have no intention to return to my formJr ~Omi4iie, and I intend to remain in FORT
PIERCE, SAINT LUC!E COUNTY, FLORIL7A, oern-~anently
. ,
/~~tL~r-C1 ~-~%L~~c4~^
(Name)
~ ~ Minnid Ellison
! ~ . (Address)
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_ - NO'VE[n,b8=_~ ~ 19 ~
Swom to and subscribed before rne tnis day of r
ROGER POITRA5 - -
CLERK CIRCUIT COURT Notary Public
• D.C. My C~mmission expires
BY - ~.C.C.~.c~ _
~ (To be execut~d in duplicate and original filed with Clerk Circuit Court, and duplicate virith Tax ~lssesscsr.j
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