HomeMy WebLinkAbout1417 Oeclaratton ot Domicil~ a~d Citiz~nship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sj. LUCIE ~OUNTY, FLORIDA:
This is my declaration of Domicile a~d Citize~ship in ths Staro of Horida that 1 am filirp this dty ~n aooordano~ ~nd
in aonformity with Chapter 222, Section 222.17, florida Statutes.
~ XO~ CiZ~01~
1 was formerly a legal rosidsnt of
. (CitY) (Sta»)
~ M='St ~LZ'Nt
and 1 ~esided at . Howevar 1 hsve chan~ad my domidle
(Street and Number)
to and am a~d have been a bona fide resident of the State of Florids si daY ~ "
I~OA~~~ BOZ ~1
, 19 and I reside at ~t
(Street snd Number)
FORT MERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residenoe and domicile in the State of Horida.
(Insen here any pertinent facts,, such as ssle of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of hofne, etc.)
Ra~tit'~d i~ Vads Itts. Cp~p~tp, i~a~~boro, xi~ CiroliHa
A~robaa~d bMr at St. ~ Bo~ 221, HatcDsr StacrsL , lbrt Pl~re~, 1~'la.
FILED AND RECOROEb;
ST. I.UCIE COUN'fY. Fl.A.
RECORD VERIFI~D
1'741'7''~'
'69 JAN Z7 PN !2 : Oq
! ROGER :OITRAS
I CLERK CIRCUIT COURT
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I fURTHfR CHtTlFY tfiat I wiil oomply with all other roquiramenfs of a Is~al ~esids~t of this Stste.
I FURTHER CERTIFY that 1 have no intention to retum to my former domicjle, and I intend :to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanensly. j~ 8~~~
ir
~i~,.~.~, 8.tts. xato~
` ' - (Name)
~ sat~lt ~.t~t, 8t. ~ Bos 221
(p?ddreu)
Sworn to and subscribed before me this ~.L~- day of ' 19_-L:
~
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ROG~ PORRAS ~ l
CLERK CIRCUIT COURT ~,.~r"~R=r~~,~~4~,~~ N~tary Public E
J..~........., ~ ti-•,-~ ibe+il? wiiK. St+h ~i qM;i~ at l~ ~
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(Te b~ uacuf~d in dupiicat~ snd ori~ieal Rl~i ~~i ~aN ax AsMa~or.)
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