HomeMy WebLinkAbout1497 1'7~~
Oe~laratio~ ot Domicil~ and C141z~nship
TO THE STATE AND COUNTY TAX ASSESSOR, ~
S~, lUC1E COUNTY. FIORIDA: ~
This is my declaration of Domicile and Citizenship in ths State of Horida that 1 am filinq thi: day in aooordano~ snd
in aonformity with Chapte~ 222, Ssction 222.17, Florida Statutes.
i was formerly a legal resident of ~iti~0l~ Md.
(City) (Sta~I
and 1 resided at 1618 Ra11b1tMOO0 ROad However I havs charpsd my domic~ie
(Stroet and Number)
to and am a~d have been a bo~a fids residant of the State of Florida sinoe lit day of
- llt~? 19.~$, and I reside at 3605 Ov~rbre~ Dri~~
(Street s~d Number)
I~ORT M~C~, SAINT LIKIE COUNTY, RORIDA
and this stateme~t is to be taken as my detiaration of citizenship, actuai legal residanos and dontiale in the State of Florids.
pnsert here any pe~tinent facts, such as sale of propery or busineas, or relinquishment of employment
at former domicile, removal of family to new domicile, purchsse of home, etc.)
FILEO ANU RECOR~ED
S7. LUCIE COUMTY. FLA.
h?E_CORn VFRRr=ED ~
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'69 M~R I ! : 46
f?Ot;ER rOfTRAS
CLERK CiRCUIT COURT
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1 FURTHER GHtTiFY that i will compty with all otF~er roquirerr~ents of a lepal rosider~t of thls State.
I FURTHER CERTIFlf that 1 have no intention to retum to my formar domidle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
G
1• ~
tNeme)
300a Ovt:br~ok Drf~~
(/~dd~s)
Sworn ro and wbscribed before me this _...3~:.~'t~y Qf.~ . 19~~
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CIRCUIT COURT - _ t • Notary Publk
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