HomeMy WebLinkAbout2067 Declaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and ~
~
in conformity with Chapter 222, Section 22~.17, Florida Statutes_ ~
~
~
1 was formerly a legal resident of __FOY't 5~11___ nkl t3hp.~a ~
(City) (State) ~
~
{
and 1 resided at __.~~3QB H8IDmel _ R08d _ _ . However I have changed my domiCile ~
' (Street and Number) ~
~
to and am and have been a bona fide resident of the State of Florida since .____SZ1riQ__l~~i~-- _ day of F
~
3
~
_ i9____, and I rESide at 160 Banyan Drive* Port St. I,u~~~ ~
(Street and Number) i
~
FORT PIERCE, SAINT lUC1E COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(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.)
F~r Homestead
t
,
~
~
~
r
F~! ED F:~IJ R~CQRL'GEJ -
j . ~c~~~;~Y. ~c_:.
~ - _ . ~
i i8~260
F~~ ~ r;ri 3 . ss :
. }
~
' ' . 1 : t . g
. . . . . l •
r ~ \ 7 ? ! ~ ~ ( ~ I I ~ T / ~ ^ t{~ T ~
~Lil 1 V l~ Vf\ ~ '
)
~
O
I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State. i
I FURTHER CERTIFY that I have no intention to return to my former domic,ile, and I intend to remain in FORT ~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. j
~ ~ r ~ ~
_ Q~ c. C t_`L t.1..~.ie`~ ~ ~
(Name) ~
~
~~C b~~ ria 1 GL. K, v~~ . ~
(A dress) ~
.
. ~
Sworn to and subscribed before me this day of , 19 _ 4
~
, f
. . i
ROGER-.POtTRAS
' ` CLERK ClRCU1T COURT Notary Public
. ~ _
: . . i~/LG ;
By•. * D.C. My Commission expires ;
. . ~
, .!4
.
' (TO be executed in dupliute and original filed with Clerk Circuit Courf, and duplicate with Tax Assessor.)
~3 B~~x182 ~A~~~0~3