HomeMy WebLinkAbout2661 . ~
~sclar~tion ot DOrniclle and Citls~nship
.~5~~45
~O THE STATE AND COUNTY TAX ~?SSESSOR, . -
S~. LUCIE COUNTY, FLORfDA:
This is my detlaratio~ of ~ornicile and Citizenship in ths State of Hari~a that 1 am fili~p thii day in aooordanae a~d
in to~formity with Chapter 222, Sectio~ 222.17, Florida Statutes.
Cincinnatti Ohio
1 was formerly a legal ~esident of
(CiN) ~ah) _
and 1 resicl~d at _ 2931 Lir.d~?ood Ave. ~WeVef j have cha~iqa~d m~? domic~le
(St~aet and Numbe~)
ro and am and have been a bona fider ~esident of the Stab of Florida since 15th day of
September fi6 469 Sanciia Dr Port St.Lucie
, 19 , and 1 reside at
. (Street and Number)
FORT MERCE, SAINT LUCIE COUNTY, RORIDA ~
and this statement is to be taken as my decla~ation of citizenship, ac~tva_I legal residenoe and domicile in the State of Flori~a.
(I~sert here a~y pertinent facis, such as sale of property or business, or relinquishment of employment
at fomner domidle, removal of family to new domicile, purchase of hbme, etc.)
Establishing residence and will apply for homes~tead
p RE . ~
R11~0 E ~OUN~ ~
gt'REC RO VERI~1'~0 _
~ ~
'6~ Z 151145
R pp~S CQUin
~ C1.EaK CIRCUIt -
~
f
f
~ 7 RJRTHER CERTJFY that 1 will oomply with all other requiremenh of a legal resident of this State.
~ - .
1 FURTHER CERTIFY that 1 have no intention to retum ta my forme~ ciomicjle, and 1 intend to remsin in FORT ~
PIERCE, SAINT LUCIE COUNTY, FLORI~A, permanently_
~~~~j
~ .
.••``t._~CO f
, ` ~ - ~ ~ (ti~me)
-,s~ ~-:`~~~#~~;p. Gordon T. Jac o~ Sr;
, y " ~ ~ 1 ' ~~r~
' ` t (Addreu)
~ ~ _;,°.:y-` ~
~ ' _ ~ t _
~ : - ~ 66
~ .~wd~'n t~ant~~subscribed before me this 27t~ day of np~em~es , 19
~ • • -
~
ROGER ~OITRAS ,
C~ItCtJIT RT Notary Public
B D.G. My Commiuion expires
~
~ Re b~ ~oc~evt~d in duplie~ and ~i~ieal fil~d witl~ Cl~~k Cirevit Cow', and dce~ wilb Tax AsNaora
a~ 162 ~ 258 :
~
, .~:~~~f - - _ _ _
t~":.~.' ' `'y"'~,:k`~F ~i . ' _ _ ~ ..:4~..
_ ~ '~N _ ~