HomeMy WebLinkAbout0499 . 1'~1658 .
~claration ot Domicile and Citl=~nship
TO THE STATE AND COUNTY TAX AS.SESSnR,
Sj. UJCIE COUNTY, FIORIDA:
This i: my declaration of Oomicile and Citizenship in ths State of Norida that 1 am fitinq this day in aooordano~ end
in aonformily with Chapter 222, Section 222.17, Florida Ststutes.
~ w.: f«msr~y e ~eqa~ re:ident of BHrberton ~hio
(Ciy) (Stah) ~
and I~ided st 28-18th St7coet ~ 3. ~ have chs
npsd mY domldle
(Street a~d Number)
to and am end have been a bona fide ros'ident of the State of Florida sinos Ootober 21 ~y ~
, ~q~, a~ i~~ ~ 404 80. 22nd Street
(Straef and Number)
FORT rl~, SAINT LUC~ CMINTY, RORIDA
and this statement is ro be taken as my daclsratio~ of citizenahip, actual legai re:idenas and domicile in the Stai~e of Horida.
pnssrt hem any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, ~emoval of family to new domidle, purchase of har~e, etc.)
8ntering child_in grade echool
Rhonda
FILE~ AND RECOROEO '
ST. ~C
E ~ ~V ~TF ~ OLA.
~ 1"71658
~sa ocT s~ 2: i o~ .
I f~0ITf2AS
CLERK CIRCUIT COU T
~
1 FURTHER CHtTIFY that 1 will oomply with all other requirsrrwnt: of a lepal resident of this State.
I FURTHER CERTIFY thst I have no intention to return to my former domicile, and 1 intend to remain in FORT
PIERCE, SAINT WCIE COUNTY, FLORIDA, permanently.
, Q~~_ ~ \ ~d~~
(Name) ereri
~m tJ 1 e `r`
' (~dfeS3~
,J• . .
Sworn to~and~sub~crtbed before me this ~5th day of OQtober tq68 .
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i • _.•~YM ~ ~
~RK CIRCt11~,C~ltRT ~ Notary Public
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By D.C. My Commission expires
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~ Ro b..oaaMd le duplis.~..nd o~tn.l tiMd wil1~ d.~lc cie~wh cowf, a~d duplic.t. wiN~ Ta: A~..,.ora
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