HomeMy WebLinkAbout0156 Decla~atio~ ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA:
i
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in actordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes. ~
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~~'y sH~~2E ,vE~a,c~,r
I was fo~me~ly a legal resident of . _ _ _ _ _ _ _ _ - _ _
(City) (State)
and 1 resided at _3~ LA~F'~llEw A~'c
_~w~ S~ .P~~~Gt"ct~Xy ~Lv,~ However 1 have changed my domiGle
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since Tti~__ day of
- - - 19 _ ~ and 1 resi e
a~-~-;- -
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
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 properry or business, or relinquishment of employment }
at fo~mer domicile, removal of family to new domicile, purchase of home, etc.)
FO~~'It~c.~. ~/rIPL~ ~r ,SE~.,_ pL/2F j~•~c~~c~c;-!~ ~~~rr~•',~F:T'T
,t3 G c/J ~A/ S/i~~'~E ~,Sp~_ D~70~~~ t /V % i/! ,~/l~lcr ts%Ay ,BLli J~ ,j3G'T ,~E i
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i~ESG"'~,?`,•'~,, ~~`NT/~Jf N~/rll .or 3G L.C'r'fEU/EK%. .
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FILED A`!0 RECORDtD
S'. LUCIE CQUNTY, FLA.
..-^nf•.i~ `a=~i'•rtEC,
~ '70 J~~~~ 1~ `~`~~5 : 28
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I FURTHER CERTIFY that 1 will comply with all other r uireiflerit~
o~'~i'~g a~sresident of this State. ~
~~ERK C'~CuiT ~OURT
1 FURTHER CERTIFY that I have no intention to return to my for r domiCile, and t intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, rmane~t! c-~~~ ~ ~
Pe Y• ~ O~ ,~~l,c.--c~.t~,.-~
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C-~ ~ ' -
• ~ A!I (-~f 7L. (Name) ~'j')p W ~R R y ~
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~ . . O~ D~/ ~y~O e~''K~t.ei'~-` ~/~~c-t+~'~ ~/It' ~
, ~ . - (Address) ~
~ =T~:~'~4't'~. . ~g
~ . .L~ . 3
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~ .~~wgm t~ anrl~.sub§'cribed before me this day of , 19~U ~
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~ ~ ~~II~CUI COURT Notary Public ,
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~ By ~ D.C. My Commission expires
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(To be executed in duplicate and original filed with Clerlc Circuit Courf, and duplicats with Tax Assessor.) ~
Y
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BOCr ~ F'AGE ~
~ 155
No. ~3
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