HomeMy WebLinkAbout1015 Decla~ation of Domicile and Citi~enship
~ 186331
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FLORIDA:
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This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and ~
in confo~mity with Chapter 224, Section 222.17, Florida Statutes. ~
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1 was formerly a legal resident of Lisa _ Oh10 _ ~
(C;ty) (State) ~
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1559 Bunker Dri~e
and I resided at _ _ - However I have changed my domicjle
(St~eet and Number)
to and am and have been a bona fide resident of the State of Florida since 2StA day of
No~ember ~q 417 South Imdian Ri~er Dri.e
_ - _ - . 19 and I reside at _
(Street and Number) ~
FORT PIERCE, SAINT LUCIE COUNTY, fLORID~1 j
and this statement is to be taken as my declaration of citizenship, adual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment ;
at former domicile, removal of family to new domicile, purchase of home, etc.) _ ,
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Place Children in School '
FtLED AND R~~ORDEp;
ST. LUCIE COUNTY, FLq;'
Loraiee Rech la yrs. RE:CORD V~R~~~EO >
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Mitcheli Jtas Rech 16 ysa. '69 DEC 186331
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~ I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State. ~
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~ I FURTHER CERTIFY that I have no intention to return to my former domic,ile, and I intend to remain in FORT ~
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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i`. - (Name) j
~ Mitcnell 8. Rech ~
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` . _ ' lst veceaber 69
Sworn to and subxribed before me this day of , 19 .
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- ROGER POITRAS (
CIRCUIT COURT Notary Public
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By D.C. My Commission expires
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~ (To be executed in dupliufs snd originsl filed with Clerk Grcuit Court, and dupliute with Tax Ass~s~or.) ~
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~t BOOK 181 ~E10~,4
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