HomeMy WebLinkAbout0404 D~claratio~ ot Domicil~ and Citizenship 151'?'~i4
TO THE STATE AND COUNTY TAX ASSESSOR,
Si. LUCIE COUNTY, FLORI~A: ~
This is my declaration of Domicile and Citizenship in ths State of Ftorida that I am fili~g this day in sooo~danos and
in oonformity with Chapter 222, Saction 222.17, Florida Statutes.
I was formerly a Isgal resident of T~rence Cat i f~
(Cify) (Stah)
and 1 resided at _ 23024 BvClq~ Ave: . However I have chanqed my domidle ~
~ ~ (Street and Number)
ro and sm and have been a bone fide resident of the State of Florida since 20th day of
t~~o...~,e~ , 19
6SL, and 1~ide at 808 Azales Ave ~
(Straet and Numbsr)
FORT NERCE, SAINT LUCIE COUNTY, RORIDA
and this stasement is to be taken as my declarstio~? of citizenship, actual legal residenos and domicile in ihe State of Florida.
i
(insert here any peninent facts, such as sale of property or bu:ineu, or rolinquishment of employms+~t
at former domicile, removal of family ro new domicile, purchase of home, etc.)
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Bstablishing residence ~ ~~EO ANO RE _
ST. WCIE~ COUp~~. `
_ RECORD YERIRI~b'"". _
Entering child in school
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I fURTHER CEItTiFY that I will oomply with all other requiremenb of a lepal tesklent of this State.
1 FURTHER CERTIFY that 1 have no intention to retum to my former domicjle, and I intend to ~emain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~~ul ~ ~
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:i~. e~' Mame)
= ~ '~~,;.~'y +i'i Lawson D. Koberts
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1 - ' . ~ ' k (Address)
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lOth Januar , t91zZ.
Sworii~to'arx! wbsuibed before me this day of Y
rORRAS
GRCUR RT Notary Public
~ dLC..E.t~~i
gy D.C. My ~ommiuion expires
Ro b~ ~~cuhd in dupiieat~ and ori~inal Ai~el wbh Ci~elc Cira~if Co~~t, and duplical~ witb Tax At~o~.)
_ e~K ~64 ~ 402
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