HomeMy WebLinkAbout2915 Declaration ot Domicile and Citi:enship 159524
TO THE STATE ANO COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA:
i
This is my declaration of Uomicile and Citizenship in the Stats of Flo~ida that I am filinfl this dsy in aooo~danoe and ~
in conformity with Chapter 222, Section 222.17, Florida Statutes. ~
(3arden ~ity Kichigan ;
I was formerly a legal ~esident of
(~ity) (Staf~)
~
and 1 resided at 29802 Chester Stl~eet . However I have chanfled my domic.ile ~
(Street and Number)
ro and am and have been a bona fide resident of the Ststs of Florida since l~b - day of
. j
J~ ~295 So Indian River Drive
, 19 67, and 1 reside at
- ' (Sheet and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenahip, actus) legal residenoe and domitile in the State of Horids.
(Insert here any pe~tinent facts, such as sale of property or business, or ~elinquiahment of employment
at former domicile, removal of family to new domicile, purchsse of home, ett.)
~ntering children in school -
Sflli
~AEIVDC RE~~~ .
RECORn~~~4
~6T AUG Ze pN IZ : 22
~ ~~'e-~a.~-c~
: ' `?OG::Ft r 41TRA$ ~
~LERK CIRCUIT COURT- '
y
, ~
~
(
~
, ~
~
I FURTHER CERTIFY that I will oomply with all otF~ requirements of a Isyal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domitile, and I intend to remain in FORT
PIERCE, SAINT IUCIE COUNTY, FIORIDA, permanently.
~~~l:~tlit:li/~~~
: ' ~ ~ O
_ t,~ ~ ~ vA ''~r
; u ~ ~ .i~
= ~ ~j~, ti~~ ~ C`i/
; ~ ~s (Name)
=J Zee Jensen
a':
• ^ ~4~~±
-r , •
Si s . ~ ~ ~
~ t. ' •.~J _
~ ~::1 ~t _ (Address)
.
. l G
c :
'~~~r~!C'$wofii'to and subxribed before me this 28th day of Au ust lq 6? -
.
i
ROGER POtTRAS - 4
CIRCUR C URT - Notary Public . ~
~ a~~ ~c~L~
gy D.C. My Commission expires
,
t
~
(To b~ ~x~c~t~d in duplkat~ and ori~inal fil«! wiTh Cl~k qraiN Coue~. and duplicai~ with Tax Aawer.) '
~ a~K1s7 F~~29i3 ~
_ .
~ ; ,
Y_ ~ ~ ~ ~ _ ,`i ~ - -
-