HomeMy WebLinkAbout0630 ~eciaratioe ot Domicil~ and Citisenship 158~34
TO THE STATE AND COUNTY TAX ASSESSOR,
Si. IUCIE COUNTY, FlOR10A:
This is my declaration of Uomicile and Citi:enship in the State of Florida that 1 am filinq this day in sooordence and
in oonformity with Chapter 222, Section 222.17, Florida Statutes.
t was formerly s le~al rosident of T.i ~nel n I11~II01e ~
(City) (Stat~) ;
and I resided at E.?l flwnver Street . However I hav~ chan9sd my domidle ;
(St~e~t and Number) ,
to and am and hsve been s bona fide mtident of the Sta» of Floride sinoe '~#h day of
.Tu1y , 19~7, and 1 reside at ~ 710 ~vnr. ain~ Avenue
(Street and Number)
FORT M~KE, SAINT LUC{E COUNTY, RORIDA
and this atatsment is ro be taken as my declaratlon of citizenship, acfuel lepal residenos and domidle in tFie State of Florida. ~
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(Insert ha~e any pertinent facri, ;uch a: sale of p~operty or bu:tness, or reHnquishment of employment
at former domicile, removal of family to new domicile, purchass of homs, etc.) ~
Sntering Guy Power in First Grade
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aN~ a~K~Y~¢~.
S~,~uc~ ~
VER~F~E~
aE -
9 ~ 9
~ '61 ~U~ ,y0`~~ . s
~ 158~ ;.v`
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~ C4~RK C~¢C
t FURTHER GERTIFY that 1 will oomply with all other requirements of a lepal rssident of this State.
. ~
i FURTHER CERTIFY ihat 1 have no intention to retum to my former domicale, and 1 intend to remain in FORT ~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~ Ma1fe) alen Pawer
~ (A?ddress)
.i`
. -~i~iiorri ~to di~ wbscribed before me this ~T- day of JL.lY , 19~.
. ~ , ~ L~ : -
~ : ` ; R~6R Ni~I.~
~~~Ulf Cpt1RT Notary Public
:
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- By ~ - D.C. Mr Commiu'wn expires
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~f~ 6~ ~x~enNel in duplicab ~nd o~inal Al~d wMh Cl~rlc Cin~i1 Ceuel, ~nd d~pficat~ wHb Tax A~wra
~ e~,K 16~ ~ 628 ,
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