HomeMy WebLinkAbout0823 ~vV~/v ~
~eclaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE ~OUNTY, FIORIDA:
This is my declaration of pomicile and Citizenship in the State of Florida that I am filing this day in accordance and
in conformity with Chapter 2,~~, Section 222.17, Florida Statutes.
I was formerly a legal resident of TSOgilr ~pre _rn _
fCiy) ~ (State) i
and I resided at _ COt~SU18te General However I have changed my domicjle
(Street and Number)
to and am and have been a bona fide ~eside~t of the State of Florida since day of i
~lBfCh , 19
6~, and I reside at 2> > N 39th !
(Street arxi Number) ~
FORT PIERCE, SAINT LUCIE COUNTY, FIORIDA
a~d this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
(Insert here any pertinent facts, such as sale of p~operty or business, or relinquishment of employment
at former domicile, removal of family to new domiciie, purchase of home, etc.) ~
establish residence `
;
FlllD AND RECORBEO"
ST. LUCIE COUNTY, F~A::
, RECORD VERIFIEb '
16390'7. ~
'68 JAN 29 PN 2: 2s ;
6• ~
r
~a~ea ?~o~zR,~s
CLERK CIRCUIT COURT
1 RIRTHER CERTIFY that I will aomply with all other requirements of a legal resident of this State.
1 FURTHER CERTIFY that I have no intention to retum to my former domiti~e, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
/ ~
(Nam
Miche l le J. r f f ia ~
i
~ - (Address) i
'.;..1:`,~;::`v:,,,-.,.`~- 29 ~ .
,Sw~o~n•~~nd,s~~;before me this day of JBnuary , 19fi8-.
` Ci ' y' . ,
. `a~c~t~¢oinqe?~ - : : ~ ~
. l ~ - ~~RWNT• Cd~f Notary Public
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By O.C. My Commission expires •
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(To b~ ~xscut~d dupllcab and ori~insl ~il~d witF? Cl~rk Circuit Cou~f, and duplicat~ with Tax Ass~stor.) ?
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