HomeMy WebLinkAbout0927 . De~laration ot Domicile and Citizenship ~
~ ~~.~0
TO THE STATE AND COUNTY TAX ASSESSOR,
51, IUCIE COUNTY, FLORIDA: ~ }
~
~ ;
This is my declaration of Oomicite and ~itizenship in the Stats of Flo~ida that 1 am filing this day in atoordanos and
~n confwmity with Chapter 222, Se~ctio~ 222.17, Florida Statutes.
•
i was forme~iy a legal resident of ~ B~~ N. C.
~ (Clty) (State)
arxi I resided et p~~~ Bar 5~ . However 1 heve chan~ed my domicjle
(Street and Number)
to and am and have been a bona ftde resident of the State of Flwide since l~ dsy oi
durie 66 203 p. 48th St.
_ , 19 , and i reside at +
(Street and Number)
PORT PIERCE, SAINT LtrC1E COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, attual legal re:idence and domitile in the State of Florida.
(Insert here ar?y pertir~ent facts, such as sale of property or busineu, cr relinquishment of employment
st former domiciie, removal of family to new domicile, purchase of home, etc.)
FII.IIdG IaR HOMESTRAD P'UHI'OSES
F~tEO AND RECORDffD
ST. LUCIE COUNTY,
RECORp VERIFI~O
.~..~./~.1.~ •
'6T JAN Y3 py ~ y
CtERK
1RCUIT COURT
1 FURTHER ~ERTiFY that i will aomply with all otfier requiremenh of a legal residertt of thls Stata.
1 FURTHER CERTIFY tfiat I have ~o intention to retum to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently_ ,
~ ~
(Name)
:~~r. (YLVIN L. BE~~ JR.
~
~ ~ ~ f~'~~~
~ ( ~ v,,
. . ~i~,?
' ~ ~~df@SS~
l,L.'•'.~ 'i
~ I S p:
; - C: vS' F
r
tA•
:Syrp~ tar ~subscribed before me this 2~ day of J~~y q 6?
.
' . . `'i; ._t/'~ : ~ ~ ~ .
. • r~'~~
~ ,
U OURT Notsry Public
c
~Y D.C. My ~ommission expires
(To b~ nacvlyd in dupli~at~ an~ ori~nsl fibd with Cl~ek Cira~if Cour~, and duplicah with Tu AsMaor.)
~164 ~ 9~6
. + 'M~~ ~ ~ ~
'F9r'I ~~2 .s~~Y V-? yw~,S~fS '~'f~}''Aw+r'~e~cy.G~~`Y ~ _ " _
F is~^ ~
~ -