HomeMy WebLinkAbout0076 . ~ _ a
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D~claratton ot Domlcile and Eitiz~~ship _
TO THE STATE AND COUNTY TAX ASSESSOR, ~C~CAO
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Sj. lUC1E ~OUNTY, FIORIDA: - . ~
Thit is my declaration of Oomicile and Citizenship in ths State of. Florida that I am filin~ this day in~ aooo~dante and
in oonformity with Chapter 222, Sectio~ 2Z2.17, Florida Statutes.
1 was formerly a(ega) ~esident of MiddletoMrn ~h10
(~iy) (State)
,
and i resided at 1008 Lafsye~teAve However 1 havechanged mKdomldle •
~ (St~aet and Number)
to and am and have been-a bona fide resident of the State of Florids aince 23rd ~y ~
A~~ust ,~q 66, a~ I reside at 1004 So 7th Street
~ (St~aet and Number) ~
r~r ndtc~, sruNr wc~ cou~rtr, aowc~ - -
and this statement is to be taken as my declarotion of. citizenship, actuat legal residenoe and domisile in the State of Fiorida.
(insert here any pe~tinent"facts, such as sale of property or busineu, or relir~quishment of employme~t
at former domicile, removal of family to new domicile, purchase of iwme, etc.)
~ Establishing residence ~ ~
. RECO -
- - ~ ~ ~ 1
15154p
~ ~M 10 t 40
- ROQER pp~d'~-~~
CIRCUIT
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i FURTHER CHtTIFY that 1 will aomply with all ofher requirerr~er~ts of a le~al rosident of this State.
I FURTHER CERT1Flf _ that t have no intention to retum to my former domicjle, and 1 intend to remain in FORT
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PiERCE, SAt{~IZiE~~'y~tJNTY, FLORIDA, permanently.
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~ ' ; : - (Name)
`~+~Y t ~ ~a ~ Bln~er Tripiett
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( !l •GO';,: _ (Address)
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~ Swom to ar~d subsaibed before me this ~tb day of JaDUSty , ~9~~,
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ROGER rO1TRA5 _ -
CIRCUR C Notary Public
gy G~'~ D.C. My Commission sxpires
~To b~ ~uaM~d ~ duplica~a and ori~inal fil~d wifb Cl~ek Cirarif Coeif, sed duplieaN wilb Tax Atwrora
. 6001I PACE -
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