HomeMy WebLinkAbout1287 Declaration ot Dor~icile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
51, LUCIE ~OUNTY, FIORlDA:
This is my detlaration of Domicile and Citize~ship in the State of Flo~ida that 1 am fili~g this day in attordants and
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~n conformity with Chapter 222, Section 22?.17, Florida Statutas.
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I was forme~ly a legal resident of ABrle
r~sville P8.
(City) (State)
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~ 4 7a Indian Creek Rd.
and 1 resided at ~ ? . However 1 have changed my domiCile :i
(Sireei ~iria' N'v.:~~~t)
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to and am and have been a bona fide resident of the State of Florida since 4th day of :
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_ July , t9~, and 1 res~de ar Boz 3290 Rt #2, I,akewodd B Park :
(Street and Number) _ ~
FaRT PIERCE, SAINT IUCIE COUNTY, FLORIDA ~
and this statement is to be takers as my decla~ation of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any peninent facts, such as sale of property or busineu, or relinquishment of employment ~
at former domicile, removal of family to nerw domicile, purchase of home, etc.) t
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residence -
FlLEO ~NQ I~~~ORDED
S~. LUCIc CQUNTY, FLA. ~
. ~^r~19Q~rEV ~
n ~ 9~~ ~
'7~ I~-.~ 9 PM I: 3
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~.~1._~_~~.~ ~
CL~R~C C~:?; urT ~p~RT
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; 1 FURTHER CERTIfY that i wilt oomply with ali other requirements of a legal'resident of fhis State.
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' i FURTIiER CERTIFY that 1 have no intention to retum to my former domiCile, and I intend to remain in FORT
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~ PlERCE, SAlNT LUCIE COUNTY, FLORIDA, permanently. / `
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D v Ga 1 le ~
(Name) ~
Boa 3290 Rt #2, Lakewood Park
(Address) ~
~.~worn.fo~ntl.iubscribed before me this 9~h day of ~~arch , ~q ?0 :
. ~ ROGER P61t~A3 ~
_ .[(:CfR~11~ COGRT Notary Public
By D.C. My ~ommissior? expires
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~ ~ •.l I'J .
' (To be executed in duplicats s~d original filed witb Clerk Grcuit Couet, and dupliwt~ with 7ax Atsessor.)
. _ BOD(~~3 P~4CE~~~R .
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