HomeMy WebLinkAbout0406 Declaration ot Oomicile a~d Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FIORIDA: . S
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This is my declaration of Uomicile and Citizenship in the State of Florida that 1 am filing this day in accordance and ~
in conformiy with Chapter ~22, Section 222.17, Florida Statutes.
I was formerly a legal resident of ___ChiCa~O _ I11i1103S a
~C~y) (State)
and 1 resided at 4832 N. Mi~gqOlla ~Wever I have changed my domiGle
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _~~LgL.~~__~Z day of
- . ~ 1_1~ ~st~n R o
(Street snd Numbe~)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA .
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida. ~
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(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.) •
Establishing donicile
~
f1~E~ RECORDED
~N~ ~~~~Y. Fl.~•
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1 FURTHER CERTIFY that I will comply with all other ~equirements of a legal resident of this State.
1 FURTHER CERTIFY that I have no intention to return to my former domiu~e, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~i~ G%~ C=~u~~1 Z-r`~~-"
, (Name) blgrit C ~
C a- !d c r n/
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~ (Address) ~ ~
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~ Sworn to and subsuibed before me this 8th day of January , ~9 70 , ;
~ : ~ -
~ RdGER POITRA4 -
~ _ CMCUR COURT Notary Public
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gy < D.C. My ~ommission expires
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(To bs ~xecuted in dupliute and ori~insl Flsd with Clerk Grcuit CouM, and duplica» with Tax Asse~or.)
800K 1~z PAGf
404
~ ~~o. 13 •
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