HomeMy WebLinkAbout1153 1~0~3g
D~cla~atlon of Dorhiail~ and Cltizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sj. lUC1E COUNTY, FIORIDA:
Thi: is my declaration of Oomicile and Citi~snship in th~ Stet~ of Horida that 1 ~m filin~ thi: day in aooordana and
in aonformity with Chapter 224. Ssttion 222.17, Florlda Statu»s.
1 was formerty a leqal ros'~dent of ~~t n naiana
~~~y~ (St~ta)
and 1 rosided at 110T2 SZOhsrig~ 3tr~st . Mowevar 1 h~w charp~! my danW1~
(Stro~f and Number) ~
ro and em and have been a bo~a fide resident of the St~» of Flotids :inos ____=~lst d~y of
O~O
8~.~t~sbea . 19~~. end 1 rKids N-~1~-~.a0°1nut r••+••~ ~i ~s~r P~~"][
(Streft and Numbsr) ~ temporuy )
ro~ r~tcE, u?i~rr wc~E covNnr, aoRrow -
and this statement is to be taken ss my dscla~ation of citiz~nship, sctud tspai residenw and domidle in the Stat~ of Horida.
(Insert hero any pertinent facts, :uch a: sale of property or business, or rolinquishmN+t of ~mployrtNnt
at fiormer domicile, romoval of family to new domicile, purchas~ of homs, etc.)
4_
• $IItel"1II$
xobsrt Teal in ths 3rd grad~ ~
and Tea~y Tsal in th~ lot grad• .
. will bs buying ho~~ ae •oon a6 poasible
.
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1 RIRTHEit CfRTIFY that 1 wili oomply with all other requirar~tts of a lepal rosident of this Sta».
I FURTHER CERTIFY that I have no intention to retum to my former domic3le, a~d 1 i~te~d to remsin in FORT
PIERCE, SrAINT LUCIE COUNTY, FLORIDA, p~manently. ~
F / i V
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(Name)lt~c~. PBUl J. Te81
~ (I~orsta)
.
~ (~dd~~s)
: - ,~t»~t:~:. ' -
l= `j' 6~xn.to.ai~Q~ybxribed before me this . 25th day S~pfieabe]~ ~q 67,
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- _ -ROG~R y pIT~R~:: .
~ j+. ~~a~~~~ ~ Notary Publk
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gy ~ D.G. - My Commission expi~
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~ (Te b~ ~x~arhd ia dYplicsN ~nd eeiain~l fN~d wilh Cl~lc qrcril Ca~, and d~plieaN wilb T+uc A~aorJ
~ i68 ~1~50
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