HomeMy WebLinkAbout0245 . ~
Declaration ot Domicile and Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR,
S1. IUCIE COUNTY, FIORIDA:
This is my declaration of Uomicile and Citi=enship in the State of Flo~ida that 1 am filing this day in accardance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes. ;
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I was formerly a legal resident of Harl eyevi l le pe~n _ {
(City) (State)
and I resided at 47~ Indian Creek Road ~~„~ever I have changed my domicile
(Street and Number)
to and am and have been a bona fide ~esident of the State of Florida sinte Ju~_~ day of
, 19 ZQ and 1 reside at Houte 2 Box 3290 ~
(Street and Numlie~)
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FORT PIERCE, SAINT LUCIE COUNTY, RORIDA ~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida. ~
(Inseri here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
!
~tering child in pnblic achool
Trisha Replogle
F~LEp AND RECORDED' ~
g?, LUCIE COU~Tr ~DLA-
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; '70 APR 2~ PM !2 ,
~ 192301-`~
~ c?i!4En ~'01?P:,S
~ CLERK C3RCUlT COORT
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~ I FURTHER CERTIFY that I witl comply with all other requirements of a legal resident of this State.
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~ I FURTHER CERTIFY that I have no intention to return to my former domiGi~e, and 1 intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ (Name)
~ Davi G. eplogle
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; (Address)
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' '`6w,~ijsr:.~•pnd subscribed before me this day of February ~~q 70 .
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';';'r;~(~~.;L~I~T Notary Public
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~ ey ~ ~.C. My Commission expires
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.(Yar.•bI`~'; ,i~ duplicaM snd ori~inal filed with Cl~rlc Grwit CouK, and dupliut~ with Tax Ass~s~.)
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