HomeMy WebLinkAbout1218 Declaratio~ ot Domicile and Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR,
ST. IUCIE COUNTY, FIORI~A:
This is my declaration of Uomicile and Cititenship in the Stete of Florida that I am filing this day in acoc~dance and
in conformity with Chapter 222, Section 222.17, Florida Stst•;;t.ea.
I was formerly a legal resident of ~h~0 _
(City) (StaM)
and I resided at _ 1?6~--S1~Ltt]LH~St~~ulevard _ . However 1 have changed my domicjle
(Street and Number)
to a~d am and have been a bona fide resider~t of the State of Florida since a.iD.tlaI~21..t_1970 day of
I gnac io
, 19 , and I reside at
treet and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual lega) residence and domitile in the State of Ho~ida. !
(Insert here any pe~tinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to ~ew domicile, purchase of home, etc.)
L
C.p.G ~ ~~'~O~"~ STIIED AND RECORDED'
. LUC1~ ~OUNTY. F~q; _ '
F~ECORD VEi~lFIEp `
;
E
'TO JAN 22, p~ ; 5
1~~~€)~ S
~0~~~ '0?TRtig
- ~ CLERK ~~RCUIT COURT:
, .
~
I
f
I FURTHER ~ERTIFY that I will . comply with all other requirements of a leyal resident of thls State.
1 FURTHER CERTIFY that I have no intention to return to my former domitile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
(Name)
f ~ 0 ,1 ~~r A U L /q /~lG ^
(Address)
7
Swor~i ,to: and~iu4uribed before me this day of - , 19~.
:
' ROGER f?o1TR/4~S ;t ~
. ;ClW[K GRCUR ~OURj Notary Public
By ~ , ' ~ , D.C. My Commission expi~es
~ ~ T;,F .t ' _
yQ`-y, _
(To bs~~in dupliwM and oriqinal Rt~d wifh G~irlc Grcuh Courf, and dupliuh witb Tax Ass~tsor.)
goUK ~8~ ~A~~ 1216
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