HomeMy WebLinkAbout0366 ~eclaratio~ at Domiaile and Citizenship ;
TO THE STATE AND COUNTY TAX ASSESSOR, ~
Sl. WCIE COUNTY, FLORIDA:
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This is my declarativr~ of Domicile and Citizenship in the State of Flo~ida that 1 am filing this day in accordance and
in confo~mity with Chapter 222, Sectio~ 222.17, Florida Statutes.
I was formerly a legal ~esident of - S~raanae
~C~ty~ (State)
ar~d 1 resided at 260?_ James Street However I have changed my domiGle
(Street and Number)
b and am and have been a bona fide ~esident of the State of Florida since ~h.--22 day of
_ . 19~_, and I reside at
- (Street snd Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my decla~ation of citi=enship, actual legal ~esidence and domicile in the State of Horida.
(Insert here any pertinent fads, such as sale of property or busi~ess, or relinquishment of employment
at fsrmer domicile, removal of family to new domicile, purchase of home, etc.)
Establishing residency °
FILED AN~ RECOROED
~7. LUC~E COUNTY. FLa.
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'7J FEB 2 6 A~~1 9: I 2
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rLc~<K C:~CU?? COURT
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1 FURTHER CERTIFY that 1 will comply witfi all other requirements of a(eya) resident of this State.
I FURTHER CERTIFY that 1 have no intention to retum to my former domiGle, and I intend to remain i~ FORT
~ PIERCE, SAINT LUC~E COUNTY, FLORIDA, permanently. 1
Q i.~ i~r . ~ ` G~~,C~~ft/
(Name) patricia A Haith
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~ • Swom~t~`and subscribed before me this 2B day of ~ehr~.Arv , 19.Zl1-.
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(tOGER POf1`RA~_
tlRCtllf. ~ RT Notary Public
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~ gy- . iy~~ D.C. My Commission expires
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~ Ro b~ executad in duplicat~ and ori~inal ~iled with CIKk Cirwit Cou~f, snd duplicah with Tax Ass~or.)
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