HomeMy WebLinkAbout0228 . . . ~S9`~'3~ . '
D~claratlon ot Domicil~ and Citi=~nship ~
TO THE STATE AND COUNTY TAX ASSESSOR,
Si. LUCIE GOUNTY, FIORIDA:
This is my declaraticn of Domicile a~d Gitisenship i~ the State of Horida that 1 am filin~ this day in aooordana and
in oonfo~mity with Chapter 222. Section 222.17, Florida Statuta.
1 was formerly a lagai resident of u~~~~4n t~.nti~clrt ~
(City) (St~t~)
and 1 rosided at ponderoas Blvd~ QeorgetoMn LOt 89 ~ hav~ chan~d.my domWle
(Sheet and Number)
ro and am and hsve been a bo~a fide ~ssident of the State of Florida sinos 30th ~y ~
/~ugnst~ , t9~, and ~ reside at 308 ~a 23rd atree! _
(Sheet and Number)
FORT ~IERCE, SAINT LUCIE COUNTY,,ROR~A
and this statemsnt is to be taken as my declaraYwn of citizenship, sctual Ipal ~esidencs and domidle in the State of Horida.
(Insert here any pertinent facts, :uch a: sale of propsrty or busineu, or mlinqui~ment of employm~nt
at former domicile, romoval of family to new domicile, purchase of tame, etc.)
Bntering Beverly preaton in the 3rd grade '
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1 FURTHER CERTIFY that 1 will oomply with all otF~er roquirornsnts of s lepal resident of this State. '
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I fURTHER CERTIFY that I have no intention to retum to my forme~ domic,ile, and 1 intend to remain in_ FORT ;
PIERCE, SAINT IUCI~ ,40UNTY, FLORIDA, permanently. ~
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, ~ _ `I • c. ~ ~ DOrls ptlsTOh ~ HIS ~rbl.'It ~
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- • Sth Septeaber ~ 67 ~
Sworn b and wbsuibsd befae me this day of - 19 .
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. ROGER tO1TRAS _
~p~ . Notary Public ~
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gY ~i?~ ~.C. My CWY1111I=ijOfl eXPlfe!
lTe b~ ~x~aK~d in duplicah snd ai~inal fif~d witb Cl~elc Circ~if Ceu~~, ~nd duplical~ wilh Tax As~ora
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