HomeMy WebLinkAbout2636 De~laration ot Do~nicile and Citisensh~p j~i~ ~
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TO THE STATE AND COUNTY TAX ASSESSOR. '
Sl. IUCIE COUNTY, FLORIDA: •
This is my declarotion of Domi~;le and ~itizenship in the State of Florida that ! am filing this day ~n aao~~ake and '
~n conformity with Chapte~ 222, Sectio~ 222.17. Flwida Statutes. •
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I was formerly a legal resident of COC08 _ Fla. ~
(City) (State) _
2026 Ivy Drive
and 1 resided at However 1 have changed my domicjle
(Sireet and Number)
to and am and have been a bona fide resident of the State of Florida since day of
January ~q_ 6?, and I reside at ?40~ Royal Palm Drive
(Street and Number)
FORT PIERCf, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my decla~ation of citizenship, actual legal residence and domicile in the State of Florida.
(I~sert here any pertinent fads, such as sale of property or business, or relinquishment of employment ~
at former domicile, removal of family to new domicile, purchase of home, etc.) '
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Establishing residence
- FILEO AND RECOROe~
ST.RECORD ~ERIFlEpLA. .
163196
'S8 JAN 2 PM 2:33 ~
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:t~~CF ~'011?:.s ~
; Cl-ERK CIRCUIT COURT i
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1 FURTHER CERTIFY that 1 will oomply with all other requirements of a le9al resident of this State.
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I FURTHER CERTIFY that I have ~o intention to return to my for er domicjle, and I interx~ t remain in FORT 3
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PIERCE, SAMlfi~lli~.l€~COUNTY, FLORIUA, permanently.
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L ~ . - ' (Nam ~
' Wiilia¦ Hodge ;
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. •r~.'. ~ (Address) S
'i~ t j^ 1 ~ 1 :
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2nd Januarq bi ;
::worn to and subscribed before me this day of , 19 . ;
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ROGER POITRAS t
CLERK CIRCUIT COURT Notary Public
~-G D.C. My Commission expires ;
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(To b~ ~x~cubd ie duplicaN snd ori~insl ~il~d with q~lc Gra~t Court, and duplicah wilh Tax Auxs~t.) ~
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; B~K169 P~2617.
' No. 13 - • - - -