HomeMy WebLinkAbout0695 ~eclaration ot Domicile a~d Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COU.NTY, FIORlDA: '
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This is my declaratio~ of Domicile a~d Citizenship in the State of Florida that 1 am filing this day i~ accordante and
in conformity with Chapter 222, Section 222.17, Florida Statutes. , '
I was formerly a legal resident of Loek Haven _ Penn. _
Kiry) (State)
and I resided at _lOT ~_$i~land However I have changed my domiCile
(St~eet and Number)
to and am and have been a bona fide resident of the State of Florida since ..s day of
19~_, and 1 reside at 1927 (;~oress Ave _
(Street sr?d Number)
FQRT PlERCE, SAINT LUCIE COUNTY, FLORIDA .
and this statement is to be taken as my declaration of citizenship, actuaf legal residence and domicile in the State of Horida. ,
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(Inse~t here any pertinent facts, such as sale of property or business, or relinquishment of employment ~
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at former domicile, removal of family to new domicile, purchase of home, eic.) -
Filing ior hodeetead eae~gtion
FlLED AND RECOROED ~
ST. LUCIE COUNTY. FLA. ~
:~r. y~~n E.rZ!=1FG ~
190452
~ '70 t~R 2 AM IQ : 55 ~
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~ CLERK~CIRCUIT COURT' ~
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~ I FURTHER GERTIFY that I wil) comply with all other requirements of a lega) resident of this St~te.
1 FURTHER CERTIFY that I have no intention to return to my former domicjle, and I int~nd to lemain in FORT :
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~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ (Name) geith W. K line
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_ - (Address) _
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. Swom to and subscribed before me this ~*•a day of , 19~_.
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ROCiER~•.POITRAS
~ CtERK CIRCUIT COURT Notary Public
~ B - - L~ D.C. M Commission ex ires
Y. Y P
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~ ' (To be sxecuted in dupliuts and oriyinal ~iled witi~ Cl~rk Grcuit Court, and duplicat~ with Tax Ass~ssor.)
No. ~ 3 60DR P~ ~~J
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