HomeMy WebLinkAbout1123 Declaration ot Donnicile and C~t;zenship ~
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TO iHE STATE AND LOUNYY TAX ASSESSOR, j~
5i. LUCIE CUUNTY, FLORIDA
(his is my deciara!ion of D~micile and Citizensh~p in the ~tate of Florida that i am filing this day ~n accordance and
in conformity with Chapter 222, 5ection 222.17, Florida Statutes.
Hilw~nkoe ~o• ~i~consin
I was torrn~rly a lega! resident of _
(City) (StaTe)
and I resided at 7111 W. w~3doAS~n kl+Ct WSLtx8t0!!b1 However i have changed rny domi~ile
(Street and Nvmberj
to and am and have been a bona fide resident of the State of F!orida sinte . ~ _ _ day of
Nav~aber 65 182 Priiea vista Blvd.
, 19_ , and I reside at . _ _
(Street and Number)
FORT PIERCE, SAfNT LIiCIE COUNTY, FLORIDA
and this statement is to be taken as my derlaration of citizenship, actual legai residente arid domicile in the State of Florida.
(inseri here any pertinent facts, such as sale of property or business, or relinquishment of ~r~7pi~yri~ent
at former dom;cile, removal of family to new domicile, purchase af home, etc.) . ~ •
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Purchasing ho~ae at 2C4 Beach Avenue~ ~eer Pa~}c
FILED ANG R~CORDED
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! FURTHER CER7IFY that I will comply with all nther requirEments of a lega! resident of ihis State.
I~URTHER CERTIFY that I have no intention to return to my former dom~~ile, anc~ I intend to remain in FORT
PIERCE, SR~NT LUCIE COUNTY, FLORIDA, permanently.
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, . d~Talter Ma~rshall
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Swom to ~nd subscribed before me this . day ~f ____..___~C~~t'8r J 19 ~5
ROGER POIYRAS _
LERK CI UIT COURT Notary Public
gY D.C. My Commission expires -
fTo be executed in duplicate and original filed with Clerk Circuit Court, and duplicate with Tax Assessor.)
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