HomeMy WebLinkAbout2586 165093 '
Oeclaratio~ ot Domlcile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FIORIDA:
This is my declaration of Uomicile and Citizenship in the State of Florida that I am filing this day in accordante and
in conformity with Chapter ~22, Section 222.17, Florida Statutes.
1 was formerly a legal resident of D~~.B~L~fl---_.--- _ 1.11 • -
~~;ty) (State)
and 1 resided at 163~_ H~Brd However I have changed my domitile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since __~4~~--- _ day of
- F$bru~r-3~-- ~ 9--G8. and I reside at 804 Howi e Ave .
(Street and Nurr.ber)
i
FORT PIERCE, SAINT LUCIE COUNTY, fLORIDA ~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Inse~t 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.)
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Establiahing residence
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Entering Kim Marie Gawencki in the 5th grade F~
LEO ANO RECORD
sr,~~v~~E^ a~?1rY Eo~
. . _ ~ . F~A.
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'68 ~ jsSQ93
~ PM ~~06
- i
CLERK~C~RCUIj, ~
T ~D~RT ~
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1 FURTHER ~ERTIFY that I will eomply with all other requirements of a legal resident of this Stete. ~
3
s
I FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to ~emain in FORT ~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
.
. ~ ' ''j' , .
z
~ . . (Name)
: 7 , .
_ ~ • Shirley ( Mra Edward ) Gawencki ~
. , ~
. ~ . • ~ ' (Address) ~
. - - .
, r _i .
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Sworn to and subscribeci before me this llth day of MBrCh , 19~_.
ROGER POITRAS
K CIRCU~ OURT Notary Public
gy . D.C. My Commission expires
(To bs sx~cuted in dupliut~ and ori~inal filsd with GIKIc Grcuit Cou~t, snd duplicat~ with Tax Aas~stor.)
sooK 170 PAGE 25 ~ 4
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