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Decla~ation ot Domi~ile and Citizenship 1g~021 '
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORiDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of _ T+08 ~.''1^11C@8 _ ~@Yi ~@Z~CO _
(City) (State)
and 1 resided at 11~5_C811@ D91 BIIC811t0 _ However 1 have changed my domicjlc
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since 18t day of
__d_uly ,~9_S9 and I res~de at 3463 So. Pinea Drive
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residencv ~nd domicile in the State of Horida.
(Inse~t here any pertinent facis, such as sale of property or business, or relinquishment of employment ;
~
at former domicile, removal of family to ~ew domicile, pu~chase of home, etc.) S
establish reeidence
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~T'lUC
E ~o~ECORpEp~
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~lp 18~~2i
JAN 30 q~,j ~ 23
CLERK{'r ~'OtT~,~
~ C1~~~'~ ~ ~Rr:
1 FURTHER CERTIFY that I will comply with al) other requirements of a(eqa) resident of this State.
1 FURTHER CERTIFY that I have no intention to return to my former domiGle, and I intend to reri~ain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~_7~~~- ~
~ l[ARIE A. DTNZ
(Name)
3463 So. Pinea Dr.~ Ft. Pierce
. .
_ ~L.)' ; . _ "t.•.
~=.i:: :-~'~~Q . (Address)
~ . ~
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. f „ J.: x
;~r'Sivpr~tQ~~c'~scbscribed before me this 30th day of January ~q~0 .
a' . , . ` ~ _ .
. : " -
_ ~ -1 R06ER 1?Q'~i~
- ~r;r ' C11~~C RT Notary Public
` t
BY ~C. My Gommission expires
(To bs exxut~d in dupliut~ snd oriqinal filed with Cl~rk CircuFt Cou~f, snd duplieat~ with Tax Ass~stor.)
BOOK~~~ PAGE1~~1'7 !
No. 13
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