HomeMy WebLinkAbout1063 15~13 I .
Otcla~atlo~ ot Dort~Icil• and Citi:enship , ' ~
~ ~
TO THE STATE AND COUNTY TAX ASSESSOR, ~
Sl, lUC1E ~OUNTY, FLORIOA:
This is my declaration of Domicils and Gitiser~ship in the Stat~ of Norida that I am filin~ this d~y in sooordanw and
in oonfo~mity with Chapter 222, Settion 22Z.17, Florida 5tatut~s.
I was formerly a legal resid~nt of ~~Ft~ Ha~ylan~
~~iy~ (Sts»)
and I rasided at ~ute 1 Box 691~ Mardala Sp1'ings . Flowevsr 1 haw thsnqec! my domitile -
- (Street and Number)
ro and am and have been a bona fide tesident of the Stats of Florids sinos lst ,~y ~
J~y , 19 and I reside at N~nte 2 Bmc 8Z„3~ ~~neea ve~La -
- (Shaet and NumbK)
FORT PIERCi~ SAINT LUCIE COUNTY, FLORIOA
and this statement is to be taken as my declaration of citizenship, actual le~al re:idenae snd domicile in the State of Horida.
qnsert here any pertinent facts, such aa sale of property w business, or relinquishment of employm~nt
at former domiciis, removal of family to new domicile, purchase of Fwme, etc.)
Establish Residency
FlLED AND RECOROE~
ST, lUC1E COUNTI~. FLA.
RECORfS V£RIFIED
'6T ~~152213 ' 03
,
i ROGER ?OITRAS
i CLERK CIRCUtT COURT
I FURTHER GERTIFY tfiat i will aomply with ali other rsquirements of a le~ai resident of ffiis State.
I FURTHER CERTIFY that I have no intention to retum to my forme~ domitile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. _
~ ~ ~
(Name) • P
Rt 2 Baoc 87
Fort Pierce,.Florida
(Address)
- .
f
:~.6wor41 toPAd subscribed before me this 26th day of J~~r'Y . 19~. !
_ ~ i
. i
- .
: = - .i~,~ Notary Public ~
. ' • ~~`J D.C. My ~ommission ex res ~
By%,`'. ~ ~
. f,~. •
+
- ='I•t•~tt':3•
(To b~ ~ocKUhd in eh~plieab sm! ori~inal ffi~d witb Cl~ek qra~it Cou~f, and duplkat~ T a ,
~ ~~~1 i
~
, ,a~~..~ ~ . . . _ _ J ~
:',v~i. -
~~r~ i
, ~