HomeMy WebLinkAbout0489 f
oeci~ratio~ o! Domicll• and Citisenship 161853 ~
TO THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, fIORI~A:
This is my declarotion of Dornicile and Citizenship i~ the State of Florida that 1 am filing this day in aooordanos and ~
~n conformity with Chapter 222, Section 222.17, Flo~ids Statutes.
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1 was formerly a legal resident of ~T CLBVELAND r OHIO
(City) - ~a~~
16000 Terrace Rd.
end 1 resided at However 1 have chanfled my domic~le
(Streat and Number)
lst da of ~
ro and am and have been a~ona fide res~dent ot the State of Florids since . Y
_ Nc+vember , i9 b? a~ ~ reside ar 2801 Wiltshire Terrace St. Lucie ~Club
(Street and Number)
FORT PIERCE, SAINT tUCIE GOUNTY, RORIDA
and this statement is to be taken as my decla~ation of citizenship, actual legal ~esidente and domicile in ihe State of Hotida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
,
Bstablishing residence ~
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fIl.EO AND RECOROEO~., ~
ST.RECCRO VuR~ED~~
161853 ~
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'61 NaY 20 PM 2: 10 }
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:~~~Ea = oiTRas .
~ CLERK CIRCUIT- COURT
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I fURTHER CHtTIFY that I will oomply with all other requirements of a leyal resident of this State.
1 fllRTHER CERTIFY that I have no intention to return to my former domicu~e, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIOA, permanently. _ `
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.;a::::::. (Name)
~oUa''~~, JOhn G. Thiel
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• ' - ~t . = ~i0fdd~f~Ei~ 7t~t~~!
- ~ J; J. l•~. ~
- Swdi~r?o~t~d suburibed before me ihis 20th day of November , 19~. ;
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~ ~ OGER PO .
IR COURT Notsry Public ~
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gy D.C. My Commission expires ;
=To b~ ~s in d+rplicat~ and ori~ina! ff{~d with C{~rlc Grcvit Courf, ~nd duplicab witb Tax /la~a~or.) ~
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