HomeMy WebLinkAbout2413 15'71.''?'i0
Oeclaration ot Domicile and Citize~ship
TO THE STATE AND COUNTY TAX ASSESSOR, •
51. lUC1E•COUNTY. FIORIDA:
This is my declaration of Oomiciie and Citisenship in the State of Florida that 1 am filinq this day in acoordanos and
in conformity with Chapter 222, Sectio~ 222.17, Ftorida Statutes.
I was formerly a legal resident of Ji?Ck80[1 - Tenn
~Ciy~ (Sta»)
Old Nedina Road
and I resided at . However 1 have charpsd my domitile
(St~eet and Number)
lat ~
to and am and have been a bona fide resident of the State of Florida sinoe day of
_ K~ , 196? , and I reside at 5614 Badger Oburt -
(Straet and Number)
fORT ~IERCE, SAINT LUCIE COUNTY, RORIDA . ~
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a~d this statement is to be taken as my decls~ation of citizenship, attusl leyal residenas and domidle in the Stats of ~io~ida. -
(Insert here any pe~tinent facts, such as aale of property or busineu, or relinquishment of employment
at former domicile, removal of family to new domicile, purthsse of home, etc.)
F~~ED qNO ~ ~
EBtablishing residence STRE~D~R vp~NTY
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~sT JUN ! 9 ~ ?
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i FURTHER CERTIFY that I will oomply with all other requirsmenis of a leyal r~ident cf this State. ~
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1 FURTHER CERTIFY that I have no intention to retum to my former domiGle, and I intend to rema3n in fORT
PI~RG6~!b~ l.tJC1E COUNTY, FLORIOA, permanently.
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Sworn to and subscribed before me this 1~ day of J~e . 19~-• .
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ROGER rO1TRA5
CIOtCUR COURT Notary Public
~.~.cyG
g D.C. My Commiuion expires
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(To b~ ~x~c~f~d in ~pliut~ and o~i~inal Al~d wiTh ClNk pewk Cou~, and dupliut~ wiTh Tax A~aor.) -
OR ~
660K PA~E 2~.
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