HomeMy WebLinkAbout0673 Decla~ation ot Domictl• and Citizenship 151950
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TO THE STATE AND COUNTY TAX ASSESSOR,
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51. tUC1E COUNTY, FIORIDA:
Thi: is my declaration of Domicile and Citizenship in ths State of Horida that I am filinq this day in acoordanoe a~d
in oonformity with Chapte? 222, Section 222.17. Florids Statutts. . •
1 was formerly a legal msident of
(CitY) (Stats) ~
198 Co~etal Ri ~ - ~
and I resided at . However 1 have chanfled my domi~ile
(Strset snd Number)
to and am and hsve been a bona fide resident of the State of Florida since ~ day of
January 6~ 120~ 3. 33rd st.
, 19 , and I reside at
(Sheet and Numbe?)
FORT PI~CE, SAINT LUCIE COUNTY, 1°LORIDA
and this ststement is to be taken as my dedaration of citizenship, actusl Is~al residenos and domicile in the Stats of Horida. ~
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(Insert hero any pertinent fads, :uch as sale of property or business, or relinqui:hment of employment
at former domicile, removal of family to new domidle, purchasa of home, etc.)
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ffi~fBRIN(3 t~iII.D IN PUHLIC 3(~i00L FILEO AND RECOROED
ST. LUCIE COUNTY~ p~q.
JO~iN WF.~.SlC Sj~ER~LL; JR. (9) , RECORO VERIFIEO
GBOR(}E AIB~ SZI~LL (6 Y~s ) ~ ~
- - - ~ '6t ~?AN 16 PM ~ : i Z
ROGER ~OITR~3 -LS1~O
CLERK CiRCUIT COURT
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~ I FURTHER CERTIFY that i will oomply with all othsr requiremenb of a lepal resident of this State. ~
I FURTHER CERTIFY that 1 hsve no intention to retum to my former domidle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ , (Name) j
,,ti~~zti~::~,,,, . _ ~
• i ? - D(~ZIS StH~M$FtAI.L `
.7 J.•• • °~r 1/ . j .
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~ y ~ _ ' ~ . = 16th - January 67 i
: Sworp ~rgl subsaibed before me this day of . 19 • ~
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CttRK IR COURT Notary Public
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gy D.C. My Commiuion expi~es
(To b~ n duppeal~ and ori~al Rhd vrhb CI~lk CirarM CewR, and dsrpliea/~ w3Th Tax A~or.)
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