HomeMy WebLinkAbout0309 1655~$
~eclaration ot Domicile and Citizenship
TO THE STATE AND GOUNTY TAX ASSESSOR,
Sl. WCIE ~OUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Flo~ida that 1 am filing this day in actordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was forme~ly a legal resident of -~than w~ ~h -
~C;y~ (State)
and I ~esided at _ $Q3 P10=lDCt.-~tt8lt However I have changed my domic,iile
(Strest and Number)
to and am and have been a bona fide resident of the Siate of Florida since _-_~~h day of
_ 1~~t~C~ , 19..~$, and i reside at 3038 Sunrise Blvd. _
(Street and Numbe~) ~
FORT PiERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, aciual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, ramoval of family to new domicile, purchase of home, etc.)
Bnteriag Children in school ,
Kim Yvonne Blacknon in 4th grade
- ~szz~r~ ~
Terri Lynn Black~on in 2nd grade
gline Perrq Blackmon, Jr. in ist grade
F~EO AND RECORDED'
ST. LUCIE COUNTY. F .
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E 1655~$
~ '66 MAR 27 AM I I: I y
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CL~RiG-CIRCUIT COURT
1 FURTHER CH2TIFY that I will comply with all other requirements of a leya) resident of this State.
I Fl1RTHER CERTIFY that I have no intention to retum to my former domitile, and I inte~d to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
(Name) 1~[1e crty H1~CYn~OII
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Sworn to arid;wbsc.~ibed before me this 27tbday of I?larch ,~9~$_. ~
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C * Nptary Public
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BY ~ D.C. My Commission expires
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'(fo. ~r,otroulid in duplicat~ and ori~inal Blsd whh Gsrk Gauit Cour/, snd duplicaa witb Tax A~or.)
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dOtRIK 1 PACE JO9
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