HomeMy WebLinkAbout1491 ~
O~ala~ation of Domlall• a~d Citis~nship
TO THE STATE ANO ~OUNTY TAX ASSESSOR, '
51. IUCIE COUNTY, FIORIDA:
This is my decla~~tion of Oomicile end Citis~nihip in th~ Stat~ of Florida that I am filinq this day in acoordar~u and
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in conformiry with Chapte~ 222, Section 222.17, Florids Statutes.
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1 was formerly e leqal roside~t of _ ~~1 - - - - - - ~
(City) (Stab)
a~d 1 ~esided at ~~7~ ~d _ However 1 have chan~ed my domlcjle
(St~eet snd Number)
to and am a~d have been e bo~a fide ~esident of the State of Florida since l~a - day of
and I reside at n~•~c ~a.~
~~-y~s,~,l ~ii.
~ . (Sneet and Numbe?) _
FORT NERCE, SAlNT LUCIE COUNTY, RORIDA
and this stateme~t is to be taken as my deciaration of citizenship, adual le~al residence and domicile in the State of Florida. ,
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(Inse~t here any pertinent facts, such as ssle of property or busineu, or ~elinquishment of employment ~
at former domicile, removal of family to new danicile, purchase of home, etc.)
Intend to ~o to aahool in ~loarids 3tat~ ~t ?a1laLus~, ~lorida
FILED AND RECORDEO`
ST.~ECORD VERIFYFD`A~~
~ . 19`7433
~ '70 QUG 20 AM 9:58 .
R0~£R POITRAS
f CI.ERK CIRCUIT COURT;
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1 FURTHER CERTIFY that I will aomply with all other requiromsnh of a Ispal r~ident of this Stste.
I FURTHER CERTIFY that I have no intention to retum to my former domicjle, and I intend to remain in FORT
E
PIERCE, SAINT LUCIE COUNTY, FIORIDA, pe~manently. '
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(Name) 1~b~tt jt. ~[aBrid~
(Add~ess)
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;~i`~i::~r;r, - TO
. t-~ - ' ? at 19
~.~..4iMFq$~td'~~d;wbscribed before me this ~ day of ~ , -
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i,~R.. '.s
,~.~t,~~~.~~~,;~, t~.
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. :-~~r . ~ - ~ Notary Public .
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: 'til
8y , - d.C. My Commiuion expires ,
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Re w ~x~c~rNi in d~plicat~ aed eri~in~l f!{~d wilb CiKk qrarif Cwrf, aed d~icat~ wNl~ Tax A~rJ
doo~ 186 ~ 1489 -
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