HomeMy WebLinkAbout2328 Declaratian ot Domicile and Citize~ship
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TO THE STATE AN~ COUNTY TAX ASSESSOR, '
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51. tUC1E COUNTY. FIORIDA: ~
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
~r~ cor~formity with Chapte~ 222, Section 222.17, Florida Statutes.
Philadel ia penn
1 was forme~ly a legat r~sside~t of -
tCity) (State)
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704 Keystone Stieet . Howevef 1 have cha m dom~uie
and I ~esided ~ - - - - r
(Street and rlumbe~) ~
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to and am and have been a bona fide ?esident of the State of Florida since ____-12th day of }
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n st 1g10 _~iuanita '
_ - 19~~_, and I reside at - ~
(Street and Number) ,
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile i~ the State of Florida.
(Insert here any per4inent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to ~ew domicile, purchase of home, ett.) ;
Establishing residence
ST' LU~j tJ0 RECpRD~D
~~CORD yUtJTy F
E~IFIEp~~' :
j63~2 ~
~ '6T r:r~ 28 p~y ~ : ~
J1
/ CIERK CIRCUIT r?~'
COUR7
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1 FURTHER CERTIFY that I will oomply with all other requirements of a(egal resident of this State. ~
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1 Ft1RTHER CERTI~7 S~ai 1 nave no intention to return to my former domicjle, and 1 intend to remain in FORT ~
PIERCE, SAIN?`.~,UC~E.C4UNTY, FLORIDA, permanently. ~
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.:~,~~t•,'.~:: . C~,~j~,- 1
, •:J~j••' ,~.V• ~ _
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;~cG ; - (Name) .
_ ~ , - Jos h sq nes ;
" _r.~ ' ; ~ ~ x F : t*. ' , ~ s
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• ' ~ ~ ~y By ~~sl
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Sworn to and subscribed before me this 28th day of ~CeIDbeZ ~ ~9b7
ROGER POITRAS
CIRCUIT C URT Notary Public
mmi i n ex ires
gy D.C. My Go ss o p ~
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,
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(To bs ~x~cuhd in dupliuM and ori~nal fil~d with Cl~rk Grwit Couet, and duplicat~ with Tax Ass~ssor.)
sooKl6y PAfE2311
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