HomeMy WebLinkAbout0506 ~ ,
D~clAratlon ot Domicil• and Citlzi~sbip ~
- TO THE STATE AND GOUNTY TAX ASSESSOR, .~51.~
sl. LUCIE COt1NTY. FtORfDa: .
Thi~ is rt~y declaratiw? of Domicile and CiNzenship in th~ State of Florida that ! am fllinp thls dayrin aooordanos and
in oonformily with ChaptK 222, Section Z22.17, Flotida Statutes.
1 was formiriy a ipel rosidenf of ~~tOD NoTth Ca]rolilla
(Giy) (Sb»)
and I nsid~d at 219 E Qu~een 3tPSet . HovwvK 1 have cha~qsd my domkik
(StrMt and Numbar)
ro and am and haw been a bona fide rosid~nt of the Stete of Florida sinoe ~ day of
~ ,
, 19 and i nsid~ at -~Q11 Misaieaiv~i ~ve
(Strset.and NumbK)
!'ORT MlRC~, fA1NT LUCIE COUNTY, lLORIDA
and this atatemsnt is to be tsk~n ss my deda~ation of dtizenship, actvai teyal residenos and domidl~ in the Stst~ of Florida.
(Inssrt hr.e srry pe~tinent facts, such at sale of propsrty or business, or relinquishment of ~mpioymsnt
at formsr domidls, remova! of family to nsw domicile, purchase of iwme, etc.)
~tabliehing reaidence FIt UC! N p ECG~Da ) .
E C uN'F1r R~,~i;~
. RECORD VERIRI~p
i871 app2y tbr ho~neatead ~ .151,~i~ •
'6~ ~AN 12 AM 1 I: I~
ROG R 1
_ CLERK CtRCUIT COUR''I~'
~ ~ ~
I FURTt~ER GHtTiFY thst 1 w1U ao~rnply with all ather r~quinm~nt= of a Ispal rosidsnt-~'f this State.
1 fURTHER ~CERTIFY that 1 have no intention ta retum to my former domic,ile, and ! inte~d to ren~sin in FORT
PIERCE. SAINT LUCIE COUNTY, FIORIDA, permanently.
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i~~ tv artd wbsaibed bsforo me this ~ ,dar of d~tnatny ~ 19 67 .
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. ROO~ lOITRA:
CIRCUiT COURT Notary Pubiic
BY °a~`'~'~' O.G. My Commission expiras
~Ti 1» wo~aM~i ~a d~iia~s a~ ~ lil~ wilb ClMic Cie~c~if Gw~, swd d~plk~h wi~i~ Tax A~~a
~ a~K164 ~ 50
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