HomeMy WebLinkAbout2955 ~ D~cla~ation of Do~»icli~ and Citis~nship . .
TO THE STATE AND COUNTY TAX ASSF5S4R, ~61482
Sl. Ll1C1E COUNTY. F10RIDA:
Thii is my dedar~tion of Domicils a~d Ctti~ship i~ tM Stah of Horida that 1 am fillny thls day in aooordano~ ~nd
in oonformity with Chapter 222. Settion 22Z.17, Horida Shtuhs.
I was formsriy a ie~ai rosid~nt of Cros~~ill~ T~nn.
tCiry) (State)
and 1 mslded at Rt . HowwK 1 h~w tha~~qsd my domidl~
(Strwt and NumbK)
to ar~d am and have bsan a bona fide nsident of the Stah of Florids sinaf -'s~ day o/
Vnvemb~r ~q~Z, ~ j~~ ~ 415 Torth 37th at~ce~t
(Stnet and Numb~r) ~
FORT MERi:g, SAWT ttlC~ COUNTY, RORICA -
and this statement is ro be taken as my dsclaration of cidzenship, actusl Ipal taid~na and domicile t~ fhs State af HoNda.
Msert hero any pertinent facts, wch a: ~ale of propsrty or busln~ss, or ?elinqufshment of empiayn~nt
at former domicile, renwvai of famity to new don~idte, qu~chssf of home, erc.)
E`ntsria~ ~loyd Jr 9herrill in the 6th rads
_ . ~
fILEO AND RECOROED~
+ S7.R~COR~ VERIFI~D~~ - -
1ss482
'6Z N~11 ~ JW 9: SS
o~uec.~
f:O~ER 'OtTRdS
CLERK CIRCUIT COURT
1 FURTHER ~HtTIFY that i wilt aompty with aU ott~er nqu~ir~fs of a le~al restdent of this Stah.
I FURTHER CERTIFY that I have no intention to retum to my former domi4le, and I intend to ~emain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FlORI~A, permenently.
~ . t
f -,~~~ti~eti;ttiitjj~~ _ , • ~ / ~ t
\ ? ~ /
V.V " t .
~ ~I.rF.j>i ~
- ~ . i , -
- , . :~t~,. ~ ~i::.
, : ; • C''=%' (N°"'°)
' ti ~ ~z ~ _ Ellsn Lonis• Sherrill
' - ~ ~ " ( l[ra $d. )
' •`-~•,.j` ~7•:Y~<a v~ ~
~~b~ ' t ~~i~''?; C .dit ~ „ .
: i• - (Address)
'.r~'~:' '•;s= : ;
. `c.~;~~': ' tr; 6th ToveaD~r 67
~S~wo~n.lp, end. wbss~rlb~d before me this day of , 19 .
,j. . .
~
ROOER ~Of tRAi
.CIRpNT COIIRT Notary PuWk
~
gY ~~~~~~'u 0 C. My Commiuion ~xpins -
Re b~ ~ac~rl~d in d~rpiica~N aMl aioiwal Ai~d w1N~ Ciwic Wsrit Co~et, aad d~pliat~ wilb Tax A~ra
~ . ~168 -
- - _ .
- ~ ~ .
~ ~ ~ : .
~