HomeMy WebLinkAbout0719 ~ecla~ation ot Domicite and Citizenship
TO THE STATE AND GOUNTY TAX ASSESSOR, .1~~~~
Sj. IUCIE COUNTY, FLORIDA:
This is my declarat~on of Domicile and Ctize~ship in the State of Florida that 1 am filinfl thi: day in aooordanoe a~d
in oonfo~mity with Chapter 222, Section 222.17, Flo~ida Statutes.
1 was fo~merly a legal resident of L~YICS~1311c plnn
(Ciy) (Stat~)
and I ~esided at Rt 3 BOx ~ . However 1 have cha~ed my domic3le
(Street and Numbe~)
ro and sm and have been a bo~a fide resident of the State of Florida since lat day of
OCtOber ~ ~q 68 ~ a~ ~ reside at 203 Cer~l Ay~
(Street a~d Number)
FORT MptCE, SAINT LUCIE COUNTY, FLORlDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or busineu, or relinquishment af employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Batiblishing residence 1~~~
F~~E~ AND RECORDEO
ST.` ~U ^~E COUNTY. FLA. ~
rr. ~,cq~` ~~;1
~~9 MAY 1 P1t 1: 2 2
~:o,~=~'~
CI~RK C!r?CV ~ F `S
COURT
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I FURTHER CERTIFY that I will oomply witfi all other requiremenis of a lepsl resident of thts Stats.
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1 FURTHER CERTIFY that I have no intention to retum to my former domicjle, and I intend to remain in FORT ~
~
PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently.
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_ ~,G ;'i~e K'.r~4~; (Name) ~
=~~,~"'r;~ - ~~o': ~ Noraan La~soa ~
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"'~'(~~r~t~ substribed before me this 'l~h day af _ Ma~? , 19_~.
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ROGEIt POITRAS 'i
CIRCUIT COURT Notary Publk i
gy ~-G ~~'~`t'~ D.C. My Commiuion expires
(To b~ ~x~art~d in dupljeat~ and ori~insl Al~d wifh Cl~elc Clra~it Court, snd duplieat~ with Tax A~or.) -
, 3 aooK iT7 .719
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