HomeMy WebLinkAbout2367 O~cl~~ation ot Dothicile and Citix~nship 16109'7
TO THE STATE ANO COUNTY TAX ASSE550R,
Sl. lUC1E COUNTY, FlOR10A:
Thls is my declaratio~ of ~omicile and Citisenship in ths State of floride that I am fili~ this day in acoordsnc~ and
in conformity with Chapter ~222. Secfion 222.17, Florida Statut~s.
I was formerly a Ipal ~esident of . P818t~8 a14.
(City) " c~0»)
snd I rosidsd at 2220 wA8tOV9r DT. , Flowever 1 hav~ charqsd my domkjk
(Strast and Number)
to and am snd have been a bona fide ~esident of the Stste of florida :inoe let dsy of
~ ~uns - 62 8t. 2 Boz 892
, 19 , and -1 wtWa at
_ (Stro~t a~d Numbar) `
~-?~RT MBCE, SAINT UlCIE COUNTY, RORIDA
and this statement is to be taken as my declarotion of citizenshlp, actual le~al r~idence end domidle in ths Stat~ of Hotids.
pnsert- here any pe~tinent facta, :uch a: sale of properry or business, or relinquishment of employmint
at former domiciie, removal of family to n~w domicile, purthass of home, etc.)
To eetabliah legal reBidenos
- Fl~EO ANp RECORDEO
ST. WCIE COUNTY. FLq,
REGORI~ I~~RIFfEp .
~ . 161a9
'sl OCt 20 PN ~ : yy~.
I~ _ CLERK CIRCUiT COURT ~
~
:
i RJRTHER CE~tTIFlf that 1 will aomply with all otfier roquirernenfs of a(epal resident vf this SMts.
I Fl1RTHER CERTIfY that I have no intention to mturn to my former domiGle, and 1 intend to remein in FORT
PIERCE, SAINT LUCIE COUNTY, fIOR{DA, permanentiy. i
~
r:-~.,~. (N1ame)
`~~µ1U111qf~I~j .
Gv it ~ c~~~,,~ HABRY ADAIds ,
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a? D
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% ~"s: G : ..1 ~ (~lddress)
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ta~~~•:-. t ~ GO~u Ootober V
~ :ti.'t/~$~I~~~1d wbsttibed befor~ me this day of - - 19~_.
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. Ld.~ -
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:r,;,
Notary Public
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: By D.C. My Commission expiros
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= Qe b~ baarNd awd e~ioieal fil~d wilb Cl~elc qraiM Cai+t and d~plicN~ wilb Tax As~erJ
_ ~ 5~1~ ~~362
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