HomeMy WebLinkAbout0550 188165 ~
Declaration ot Don~icile and Citize~ship ~
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TO THE STATE AN~ GOUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in etoordance and
in oonformity with Chapter 222, Section 222.17, Florida Statutes.
1 was forme~ly a legal resident of sttlilt Plorids
(City) (State)
and I resided at ~ S13 Jef feraon A•e, COril Gildeas ~„revef 1 have changed my domiSile ~
(Street and Numbe~) ?
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b and am and have been a bona fide resident of the State of Florida since lst day of ~
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Pebrnarp , 19 b9 , a~ i ar 412 Cocoanut A~e. , Ri~es Psrt
(Sheet a~d Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declarotion of citizenship, actual legal residence and domicile in the State of Horida.
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.) ,
FILED AND RECORDED
ST. LUCIE COUNTY. FIA. :
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188165
'~0 J~If~ 12 P ' 22
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~I t~~iiR.~-.'J :
i CLERK C1RCUtT COURT
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1 RJRTHER CHtTIFY that I will oomply with all other requirements of a leyal resident of this State. }
I FURTHER CERTIFY that I have no intention to return to my former domiGle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. p ~/r. ~
vfi,~ Sl
Mt JaEtx G. r~+t~LBR
(Name)
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~ ~ ' 412 Cocoanut A~e River Parlc
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~i~iatrT`tol~'substribed before me this 12th day of J~uarY , 19
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~ROaIER'.1~otTRAs
CIRCUR COURT Notary Pubtic
By D.C. My Commiuion expires
(To b~ ~x~cuhd in duptiut~ snd o~yieal ~il~d with Cl~rk Graiit Court and dupliu» with Tax As~~t~or.)
BOOK ~8~ P11GE 54~ . ,
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