HomeMy WebLinkAbout0076 . D~claratio~ of Danlail• and Citis~nship _
TO THE STATE ANO COUNTY TAX ASSESSOR, ~
51. LUCIE COUNTY, FIORIDA: ` ~ ~
This is my declaration of Oomicile and Citizenship in the State of Flo~ida that 1 am filirp this day in aooo~dsnos and
in oonformity with Chapte~ 222, Section 222.17,-Flotida Statutes.
I was fo~merly a legal resident of L!~ ~ ~~L' ~~v
(Ciy) (State)
9~~ ~T/D~ v ~ ~0~~ wever 1 have cha m domidle
and 1 resided at ~ ~9~ Y
(Street and Number) ~ .
to and am and have been a bona fide resident of the State of Florida sinoe day of
19 and 1 reside at ' ' " ~U 'T /L~ ~a'~~ ~
' i~'
. ~ ~ D (Street snd Numbe~)S r~~ ~vT~
a~ ~/VS~C~/ /Q~
iORT ~IERCE, SAINT LUCIE COUNTY, RORIDA ~"~'~~~i F~~I
.33 y7s'~
and this statement is to be taken as my declaration of citizenship, actual legal residence a~c! domicik in the State of Horida.
(Insert 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.) p
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/ ~~D` FIIED ANQ RECORDEO
ST, lUC1E COUNTY. FLA.
i~rCORD V~RI~"'Fp
- ~ ~9645'7
_ '70 JUL 2 7 AM 10 : 3 9
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. ~ "::(?;FP, r'OfTRA~
CL~RK CIRCUIT COURT~ ~
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~ i FURTHER CERTIFY that I will oomply with sll other rsquirements of a lepal resident of this State. .
~ ~ I FURTHER CERTIFY that I have no intentiQn to retum to my former domi~ile, and 1 intend to remain in FORT
~ /~/~~E ~ c t-a v- d -
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
;.t~~.r•• ~~;t~f:.~_: ~
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'!4; n` % ~ (Name
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'E' - °i"~ : U~ddress)
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"Sv~ro~'?1'~o and subscribed before me this ~ day of , 19~
ROGER PO~TRAS
CIERK CIRCUIT C URT Notery Public
By ~ D.C. My Commission expires
(To b~ ~x~cuhd in duplicat~ snd o~inal r~l~d whh Cl~elc Circ~h CouN, and duplic,af~ with Tax A~s~sr.)
g~1~-~~A~ ; 7~
No. 13
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