HomeMy WebLinkAbout0927 ~
Declaration ot Don~icile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FIORIDA: Z~~~,~~
;
This is my decla~ation of Dom~cile and Citizenship in the State of Florida that I am filing this day in accordance and ~
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a tegal resident of NOYYAto _ . C_Al~
~C~ry~ (State)
and I resided at ~~a0 Y1a'6a However 1 have changed my domicjle
(Street and Number)
September 24 de uf '
ro and am and have been a bona fide resident of the Ssate of Florida since Y
, 19_ T~ , and I reside at _?Q* $o~h-6 - -
(Street~and Number)
FORT PIERCE, SAINT lUC1E COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Flo~ida. ;
~
(I~sert here any pertinent facts, such as sale of property or business, or relinquishment of employmer.t
at former domicile, removal of family to new domicile, purchase af home, etc.)
Geraldine, .Tacqneiins, A~m ltarie GenaPear
FlLEO ANO RECOR~ED~
ST. ~UCIE COUNTY. F~A:
RF C(~R~ V~ R,FIED
~~SJ` ) j
'10 SEP 25 pN Ss -
s ;
kO~E~ POITRAS ~
' CLERK CIRCUIT COURT~ '
{ ~
~
6
~
I FURTHER CHtTIFY that I will comply with al) other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domic,ile, and I intend to remain in FORT
PIE~CE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~ ~ t~
? ~c.~.~.~~ - -
- (Name ~yily ~h
~
~ - -
~ (Address)
~ .~~~.:~~r:i.,..
, ;t•'~. ~ ~ ~':f~
:
';1ti~~...~.i'V'~/=4•,s',r~: ~
' , 19 TO
~d1~~ubscribed before me this 2 _ day of ~~e~er__- -
, ~ ~ e4 ~ ~i
~ a ' ~ ~
• ,t~~~4~ 0 ~ a ~ ~ -
_ . C :
. b- '1-' . ~ . ~ •
- . . •
- ~ -
~.~~~~';~'7 ~ RT Notary Public
: / ,
~ • v ~
gy U1 D.C. My Commission expires -
~~r~~ t~ '
(To be execuNd in duplicat~ and originsl filed with Clerk Grcuit Court, and duplicate with Tax Assessor.)
BaoK187 9,2'~'
No. 13
~a~ ..3~ ~ ~ ~ _ - - - - ' r
- - ~ r~~°~~ _ . .