HomeMy WebLinkAbout0698 D~cla~ation ot Doimicll~ and Citi:~nshlp 1~~~
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, fIORIDA:
This is my decluation of Domicile and Citizenship in the Stats of Florida that 1 arn filin~ this day In aooordano~ and
in co~formiy with Chapter 2Z2. Section 222.17, Florida Statutes.
1 wu f~msrly a Ieyai ~esid~nt of greamat 1 Pet]n.
(City) (Stat~)
and 1 rosided ~t 2621 Cynwyd Ave. . Fbw~ver i have chan~sd my domkil~
(Street and Numb~r) ~
ro and am and hsve been a bona fids msident of the Staro of Florid~ sinoe 9th day of
September ,~q 68 a~ ~ 111 B. Aldea St. , River Park
~t and Nua~ber)
I~ORT MRC~, SAWT LtIC~ COtM1TY, RORIDA
and this staternsnt is to bs take~ as my dedaration of dtiz~snship, attusl legal r~sidenos and domicile in the Stats of Horida.
pnsert here any pertinent fact:, such as aale of property or business, or relinquishment of employment
at form~ domicile, rsmoval of famlly to new domidle, purchase of har~e, etc.)
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NO~R~'~Q~~~~-p'•~
5
,~VCpa C~~~Y~~
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9 p~ 10' -
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POITRAg ?I
R~ CIKCV~t C~VR
~LER
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1 FURTHER CHtTiFY that i wlll aomply with ali othsr requiremsnts of a le~al rosldent of this Stats. ~
~
,
I FURTHER CHtTIFY thst I have no intention to retum to my domi4l a I' ~emain in FORT
PIERC'~,. SAINT UKIE COUNTY, FIORIDA, permanently.
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~~~~~,~i;~~~:,,';~ BRNEST C. SPILLER
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: .pG (Name)
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d vS.
As ~ w
~ ~ ~ ~ _ y: p. a.
~ ' ;r. ~ i l l B. A ldea St. River Park
. ierce a.
_ riQ _ (Address) ~
~ . . . •
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y~'.S~y~'•?o and wbsuibsd before me thi: 9th day ~ January , 19~2_.
ROGER rO1TRAi
C~CUR COt~T~ Notary Publk
By ~ • u'~'QC. My Commiuion expires
R~ b~ ~oawha M d~ul~ apd o~in.l fU~d witl~ Cl~k Cirarir cowr, and d~eaa wiN~ Taoc AN.«ora
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