HomeMy WebLinkAbout0385 Oeclaration ot DomiCile and Citizenship ~
i0 THE STATE ANU COUNTY TAX ASSESSOR,
51. lUC1E COUNTY, FIORIDA:
This ~s my declaration of Domic~le and C~tizensh~p in the State of Flo~ida that I am fil~ng this day in acco~dance and
conformiry w~th Chapter 222, Sect~on 222.17, Florida Statutes.
I was formerly a le9al resident of COIUlR~1.~~ _ QY11Q _
(City) (State) ;
i
i
523 Stanbery Ave:.ue '
ano 1 resided at _ _ However 1 have changed my domiG~e ;
(Street and Number)
fo a~d am and have been a bona fide resident of the State of Florida since ~_UIIe Of 1968 day of
, i9_ , and I reside a? _ 2503 Sunrise Blvd
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida. ;
(Insert he~e any pprtinent facts, such as sale of p~operty or business, or relinquishment of employment ~
:
at former domicile, removal of family to new domicile, purchase of home, etc.) ~
s
Establis~ing resi3ency
i
ST ~L
C E C UN~ FI:A:~
k~CORp VERIFrEO f
~
~.:~~~,2~ !
'l0 SEP f 8 pM 3: 2 8 ~
~ ~ ~
ROGER pp~T~ '
CLERK CIRCUIT COURTJ ~
a
j
S
c
i
i i
6
l
e
i
6F
i
~ .
~
R
~ I FURTHER CERTIFY that I will comply with all other requirements of a(egal resident of this State.
i FURTHER CERTIFY that f have no intention to return to my former domi~ile, and I intend to remain in FORT
FIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently. ;
~
~ , _
~ _ _ _ _
~ (Name) def?~t'd D. Grove
~
ti
- - - - - - -
~ -
~ (Address?
d-,
~
~
.
~c3 Se^te~.ber ?C
~ Sworn W snd subscr~bed before me this _ _ day of . Y_ _ _ _ _ 19__. _ ~
~ ~ '~'~'.~j1j..C0.``:;
~ _ . . _
V .''~~f, • , - - ~ - -
i 3
:r o ~ Notary Public ~
/ ~
~ , - D.C. My Commission expires t
1. . \ ~ ~ ~ S
• ~Kr. f ~ `.4 -r•i :
J-• 'it R.!
/ .i. r . . •
.r..••'~.
~~0~ ~,~•~d in dupliuN and oriyin~l ~il~d with C1~rlc Circuit Courf, and duplicat~ with T~x Ass~ssor.)
` „ E,~R~1~7 r~~E 3~5