HomeMy WebLinkAbout1402 ~ itiz~nshi ~
Declaration ot Domicile and C p
~
TO THE 5TATE ANb COUNTY T.4X ASSESSOR,
~ ~~~~~~~~~f
51. IUCIE COUNTY, FLORIDA:
This is my dedaration of Domicile and Citizenship in the State of Fiarida that I am filing ihis day in accardante and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
i i was formerly a legai resident of ~ter~-~
(City) (Siate)
° a~d I resided at _ ~i~ Oaklaliri A"vs._ _ Howevar I have changed my domicjle
(Str~et and Number)
to and am and have been a bona fide resiclant of the State of Florida since $t$__ _ day of
' oetober • 6 , and i reside at ?06 Pa1m,Av~e~___
_ ~ 9- - - - -
(Street and Number)
FORT PIERCE, 5AIWT LUCiE CQUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domitile in the State of Florida.
(Insert here any pertinent facts, such as sale ef property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purcl~ase of home, etc.) ~
Est~blishing residency
Will ~PP~4 for hrnaestead ~N ~1,10 RECQR~JEt3
~ ' 3 0
`u`~Wy~- 0 K
~
S DEC I y `
P~N 2 : Z 3 }
. , ~~tl~~*~ar~ ;
: •.JL.) S
; .
: R06ER i~~i-i ~:,S. CLE~ , ~
. LUCI~ COtJNTY, ~
~
. FLORIDA ;
`
i ~ ~
, f FURTH~R CERTIFY that I will comply with ai) oth~r requirements of ~ legsl resident of ihis State.
{ FURTHER CER7IFY that I have no intention to return to my former domicile, and I intend to remain in FORT
'•~~~}~'f:lj~J
PIERC~,•.$At1V~~lrlfs,lE COUNTY, FLORIDA, permanently.
. . ; .
- • ' - ' O_-~ ~ _~'~.~'~v~~
- (Name)
, ~ Lou1s E. G~atie
' . . . . .J'''z.~-.~.`- ~C~-~ s<.~,
. _ ~ Iz~ne R. ~S> Cz~an e
Sworn to an~ subscribed before me this day of ~~8r--- , 19.~.~_•
ROGER POITRA5 -
RK CIRCUiT CO RT Notary Public
gy~ G~-~~~ ~__~'~~~'L-- D.C. My Commission expires _
(To be sxecuted in duplisate and original filsd ~r~th Clerk Circuit Caurt, and dupliat~ with Tax A~sassar.)
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