HomeMy WebLinkAbout2428 Declaratio~ ot OomiCile and ~tttYenship 185i34
TO THE STATE AND COUNTY TAX ASSESSOR,
51. lUC1E ~OUNTY, FLORIDA:
This is my declarotion of Domicile and Citi=enship in the State of Florida that I am filin~ this day in eaoordante and
in oonformity with Chapter 222, Section 222.17, Florida Statutes.
f7'YY~e ~
I was formerly a legal resident of
(City) (Stah)
and 1 resided at ~ . However 1 have chan~ed my domic~le
(Street art~d Number) ~ ,
b and am and have been a bona fide ~esident of the Staro of Florida sinoe /O~ " day of
v , 19~~, and I r~- ide at ~~0'"
~ eet a Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORtDA
and this statement is to be taken as my decla~ation of citizenship, actual legal residenoe and domicile in the State of Florida.
(Insert here any pertinent fads, such aa sale of property_ or business, or relinquishment of employment
at ~ormer domicile, removal of family to new domidle, purchase of home, etc.) '
~
.
t,c.,v~- .~~~+L~.G
FILEO ANO RECORDED~
ST. LUCIE COUNTY. FLA. .
itECORt) V=RIF{~D
. 185134
~ '69 NOV 4 PM t2 : 3a~~-~
~v
E ~
~ ROGER i 0lTRAS
~ CLERK CIRCUIT COURT` -
I
1 RIRTHER ~HtTiFY thst 1 will oomply with a{I otFier requirerr~snt~t of a lepal rosident of thi~ State.
1 FURTHER CERTIFY that~ I have no intentiQn to retum to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
. i.....~,+U ' ' .
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~ t (Name)
~ `i ~J ' _ 7 : •
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l~
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, ~ ~ +
. ~ _ (Address)
. :
(jr.', .t,~ 1`~'``~ ~
+ ~iou~is~c.. , 19 ~ ~
••&wor+~i~ and subscribed before me this day of - -
ROGHt rORRAS .
~/C<~~~ " - Notary Publk
/C/
g D.C. My Cornmiu'wn expires
Ro b~ ~x~whd in dupNcai~ and ori~in~l Al~d wHb Cl~k Circ~it Cour1, aed duplk~t~ wilh Tax As~ora
aooK 180 ~ 24~5
No. 13
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