HomeMy WebLinkAbout0805 ~ 1'73'745 :
D~cla~atioR ot Domicil• and Citis~nship
TO THE STATE ANO GOUNTY TAX Awi5ES50R,
Sl. LUCIE COUNTY, FLORIDA:
This i: my decla~ation of Oornicile and Ctizenship in ths State of Florida thst 1 ~m filin~ this day in eooordano~ and
in oonfotmity with ChapM? ~22. Sattion 222.17, Florida Statutea. ~
1 was formerly a leqal raident of ~atertn~n C^rr
(City) tStst~)
and 1 r~sidsd at Bi dr~l 1$i 11 Bna~ . HovwvK 1 hav~ charqsd my domidl~
(Street and Numbsr)
ro~nd am a~d have been a bona fide rosident of t!~ Staro of Florida sinoe 8th day ~
Ju11e , iq~t~, end 1 roside at 406 Peal ar ~w
(Street and Numb~~) -
lORT N~CE. SAINT Lt1C1E COUNTY, lLURIDA
and this :tatemsnt is to bs taken as my declaration of citizenship, actuai Ia~al ~esidenoe and domicik in the State of Florid~.
pnssrt here any pertinent facts, such as sale of property or buainess, or mlinquid+ment of employmant
st formar domicile, removal of family to nsw domiale, purchsse of horne, ~tc.)
Batabliahing 8eaidency for Home stead Purpoeea
RI1.ffD I?N~~RfCORO~[~~
ST.1UCiL COUNfY~ l~LA.'
R~c~73'~F5_°
'S9 JAN 10 PM 2: Oq
RO R POITRAS
CLERK CIRCUlT COURT?
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1 fURTHER CtRTIFY that 1 will aomply wiih ali ott~ roquirem~nb af e lepal resldsnt of thk State.
I FURTHER CERTIFY that i have no intention to return to my former domitile, and I intend to remain in FORT
PIERCE, SNINT UKIE COUNTY, FLORIDA, permanently.
(Name
406 Poplar Ave
~ (Address)
~
SMrorn ro and wbsuibsd bsfore me this 10 day of - JBriuet~ , 19.~.~_.
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ROOiR ~OITRAf r,.
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CLMK C~pNT COURT ' : Notary Publit
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