HomeMy WebLinkAbout1119 :1 ~l( i~,
Declaration ot Domic~le and Citizen$hip
TO THE STATE AND COUNTY TAX A~~ES,SOR,
Sl. LUCiE COJNTY, FLORIDA
Tlifs is rt~y declaration of Dom~cile and Cit~zensh:p in the Stat~ of Fiorida that I arr, filing this day in accordance and
.n conformity -ith Chapter 222, Section 222.17, hiorida Statutes
I was formerly a legal resident of ~~H BRANC~ J•
(C_ity) (State)
and I resided at archard Dr. _ Hewever I have changed my domi~ile
(Street and Number)
1~~ _ da of
to and am and have been a bona fide resident of the State of Fiorida since . - - Y
Sept. , 19_6~ , and I reside at ~~58 Overbrook__Dr. ~ P, 0. 895 _ _
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, ar.tual legal resi~ence and domicile in the State of Florida.
(Insert here any pertinent facts, suct~ as sale of property er business, or relinquishment of empioyment
at former domicile, ~emoval of faniily to ne~v domicile, purchase of home, etc.)
FILING FOR HCM.ESTE,IID PUR~OSES
f=f! ~D t~ND P,ECORDEC
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I FUR7HEl2 CER7IFY tha'r i will comply with all other requirzments of a legal resident of this State.
I FURTHER CERTiFY lhat I have no intention to return to my former domi~ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORID/~, permanently.
~ ~'[.C R•Y,. - - '
(Name)
'
; , WII~,I~M S. ~TRTKEY~
, V~ ~ j~ • _ ~Address? -
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:..s~ . . ; . „ 8tn nEC~sER 65
~worn-i,~~~cj:=subscribed b~fore me this _ day of 14----•
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~~~~~~3~RtPOIT
CLERK CI U C URT Notary Public
gy~ 4 D.C. My Commission expires
(To be execute~) duplicate and original filed with Clsric Circuit Court, and duplicate with Tax Auessor.)
Boo~ 132 51~