HomeMy WebLinkAbout0228 Declaration ot Domicile an~ Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNN, FIORiDA: ~
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This is my declaration of Oomicile and Citizenship in the State of Florida that I am filing this day in accordance and ~
in conformity with Chapter 222, Section 222.17, Florida Statutes. 3
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1 was formerly a legal resident of ~ _ LOUISVILLB KY '
(C;ty) (State)
and I resided at 1005 SSle Avc.~ However 1 have changed my domiti~e '
i
(Sireet and Number)
to and am and have been a bo~a fide resident of the State of Florida since - 30th day of
october ,~q
59 and I reside at llil Sunrise Bl~e.; Ft. Pierce, Pla.
ree an
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence a~d domicile in the State of Ho~ida. ~
(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 i~ome, etc.)
FtLED AND RECORD~p_ ,
~T• LUCtE ~OUNTY, Ftq. ~
- '?r ~Or?,^, +/'~(~!FU
xomestead 1`~' ~1~
'l0 J~~l 6 AM II: 04
I .:n~:_ k :s s~~
i ~ CL~RK C?RCL?;T ~OJRT
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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 domiCile, and I intend to remain in fORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. f
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~ C~~~~ ~ ?ti~ ~
~ ' ~ " C~IARI.ES R . iNH TTB ~
~ • ` - - , ~ ' (Name)
~ . ~ . ~
~ ` ~ n: , = . 1111 Sunrise Bive. , Pt. Pierce
~ , (Address? 12t.
~ " • ~ .....1 \i~`..~
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~ Sworn to~a4id subscribed before me this bf11 day of ~anuary , 19~~.
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~ - ROGER POITRAS ,
~ K CIRCUIT COURT Notary Public
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~ 6y D.C. My Commission exp+res
s
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~ Ro bs executed in dupliute and ori 'nsl 1. with Clerk Circuit Cou~t, and duplicate with Tax Ass~s:or.) ~
~ ~ oK~~2 p~~E 227. i
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~ No. 13 - ' ' -
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