HomeMy WebLinkAbout2523 1'?''1~015
~eclaratio~ ot Domicil~ and Citisenship
. ~,~d .
TO THE STATE AND COUNTY TAX ASSF.SSOR. ' , e
Si. lUC1E-COUNTY, FIORIDA:
This is my dacla~ation df Domicile a~d Gitisenship in the Stats of Horida that 1 am fiiln~ this day in eooordanos and
in conformiy with Chapter 222, Section 222.17. Florida Statutfs. ,
1 was forrt~erly a legal resident of ~1(l
. . . (Cih?) (Stats)
. ~c~~Fi.t~c~
and 1 residad at d~Z~ . However 1 have changed my domiyle
(Street and Number)
ro and am and have been a bona fide resident of the State of Florida sinoe 3~~ day of
.
, i~.~, and 1 reside at ~~QQ1 ~L~ ~ . 3 3~!~
(Street and Number)
FORT MHtCE, 3AINT lUC1E COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
(Insert here any pe~tinent fscts, such as sale of properry or business, or relinquishment of employment
at former domicile, removal of family to new domidle, purchase of home, etc.)
~1
a~~ R~N'~o~~.
~E~
T. Ro ~Ea~f
s RF ~~~1ai5 ,
~ ; g3
.6~ OC~ ~ ~ .
~ Ro~ER cu~
C,-ERK C~R ~ ,
f
~
E
i
I FURTHER C~RTIFY thst 1 will oompty with all other requiremsnri of a le~al resident of this State.
.
1 FUR~FIER CERTIFY thet I have no intention to retum to my former domicjle, and 1 intend to remain in FORT
PIE~tCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
.
~ ' _ . .
. a3. ~ I . •4 '
. :~t:,. ~ . , (Mame) .
' : ~''.,f ~
STA_T~2C~ ~EI~. . ~ ss. ,
3~ ~
cot~~
. , w 6~ y
j
~ ~ `s~•t ~
s ti"1Y '4.s.
' j cS ~
- rKr~:• T,
e' ' ' ~ /`i
1' Yi
't~ed t~efors me this ' day of , 19.f~.
~h '~r31.``,'~ .
~ . • .
i'.....
~S i
C~tlt CIRC1pT COt1RT Pbtary.Publk
6y O.C. My commissbn •xpirs~ / !
a. r. .~o.w~i b~ a~M. .ri,M.~ Ai~i wiN~ a.~k a~ c~, d~ifo.» ,~vir~ T.x A......ra
6~~~ PAC(~~ ~
tio. F 9 ' ~ ~
_ _ W ,
--'.a,~.,~x~~.'~~ _ -s-.-~!~, . ~ s_ . _