HomeMy WebLinkAbout0133 Decia~ation ~~,1` D~~i~ii~ afltf CltlzenSh~p
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TO THE STATE AND COUNTY TAX ASSESSOR, •
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51. lUC1E CQUNTY, FLORIDA: ~
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This is my declaration of Domicile a~d Citizenship in the State of Florida that 1 am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes. ~
• T oms River New .Terseq
1 was formerly a legal resident of _ - _ -
~~;ty~ (State)
and 1 resided at Cldai G1eO_Cit_y_ 38 ChCStDUt_ However 1 have changed my domitile
(Street and Number)
3rd
to and am and have been a bona fide resident of the State of Florida since day of
_ A~r~l 69 702 Gatden Ave.
- - - - (5treet and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FtORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domiciie in the State of Florida.
(Insert here any pertinent fads, such as sale of propery or business, or relinquishment of employment
at former domicile, removal of family to new domicile, pu~chase of home, etc.)
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Establishing residence
FILED AhD RECORDED
cT, IUCIE COUNTY. FLr_
f`;"1:~i1 ~i _ tc ~ r
18`78~2 -
'TO JA~! 5~1 I I: t 6 ~
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i ="~i=_? i•O~iP.:.S~
( CL£Rt~: CIKCt,~IT COURT
t FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicale, and I intend to remain in FORT ~
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PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently_ ;
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' ~ • (Name) '
~ ~ ~1tIICI • SCtlIDalt2 ~
(Address)
•~~Sworn'td'a~i! subscribed before me this Sth day of Januiry ~ 19 ?0 #
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ROGER POITRAS
K CIRCUIT C URT Notary Public
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By D.C. My Commission expires =
3
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(To bs executed in dupliute and orig+nst filed with Clerk Grcuit Court, snd dupliute with Tax Assessor.)
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~ ~~JRK ~~J~ F'At,C .L•.j•J
No. 13
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