HomeMy WebLinkAbout0991 Declaration ot Domicile and Citize~ship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FIORIDA:
This is my decla~ation of Domiciie and Citizenship in the State of Florida that 1 am filing this day in accordance and
in tonformity with Chapter 222, Settion 222.17, Floride Statutes.
I was formerly a legal ~es~der,t of Gary _ Ind. _
(City) (State) ~
and 1 resided at _ 405 YsY1BuZ'sYl St . ~~„~ever 1 have changed my domitile
(Street and Number) ~
to and am and have been a bona fide resident of the State of Florida since 15th day of =
1
2501 N. Fed Hv~ . '
_NpVembBP____, ~9
6~, and I reside at • y
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of c~tizenship, actual legal residence and domicile in the State of Florida. ~
(Insert here any pertinent facts, such as sale of property or business, or relinquishme~t of employment ;
at former domicile, removal of family to new domicile, purchase of home, etc.)
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Establish Residency
FILE~ AN~ RECOROED=.
ST. LUCa~n °vERTF E~LA. ,
F ~.~2s ~
! • h1AY ~ P~I 3:05 ~
, 70 ;
~ ;~e: "~o!' COURT' :
~ CLERK.~~~EUIT
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I FURTHER ~ERTIFY that I will comply with all other rec~uirements of a legal resident of this State.
1 FURTHER-GERTIFY that l have no intention to retum to my former domiCile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. $8ttle Anders
(Name)
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~ (Address)
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J U j5`ry~~rA~Jo and subscribed before me this 1 S t day of ~ay , 19 7~ . ;
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~ . R' . Ci~ITACOURT Nota Public ~
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8~?, ~ D.C. My Commission expires
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~ ~xecuted in dupliute ~nd oripinsl Fled with Clerk Grcuit Court, snd dupliwts with Ta~c Assessor.)
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