HomeMy WebLinkAbout1427 ~~~31f~
D~~laration ot Domicile and= Cltizenship
TO THE STATE AND COtJNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FLURIDA_
This ~s my declaration of Domicile 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 fo~merly a legal ~esident of ?S$8VP8II0 ~~BCOIIS~tIt . ~
(Ciry) (State) .
and I resided at Rt 1 Rivers PO~rit However I have changed rr:y domic,ile
(Street and Number)
ro and am and have been a bona fide resident of the State of Florida since 30 th . _ day of
September ,~9 7~ , and 1 reside ar _ Causeway ~obile Home Park _
(Sfreet and Number)
FORT PIERCE, SAINT LUCIE CQUNTY, FLORICA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Inse?t here any pertinent facis, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Establishing residence
FILEO AN9 RECORDEDg
ST. LUCIE COUNTY. FIA.' ~
RECORt? VERIF'~D
19931E ~
'70 OCT S PN 2 :0~~
fiOGEr~. POITRAS
CLERK CIRCUIT COURT;
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~ I FURTHER CHtTIFY that I will comply with all other requirements of a lega! resident of this State.
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~ 1 FURTHElt CERTIFY that I have no intention to return to my forme~ domiute, and I intend to remain in FORT ~
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ _ 1~~ [ct`-scr v - z~ _ ~l~~ .,-~c -
~ - - ~ . (Name)
~ ~ " a = . Marion Yan Laanen
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4 ' C + - `'C.~al`~'
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~ Swom to and subscribed before me this ____~th day of OC_tOb6I' _ 19_7~
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~ ROGER POITRAS
Ck~RK CIRCUIT COURT - Notary Public - - t
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~ ey i1 ` l ~ D.C. My Commission expires ;
~ (To b~ ~x~cut~d in dupllut~ and ori~inal ~il~d with Cl~ric Grcuit Court, and duplicat~ with Tax Ass~sw?.)
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~ „ eoRK 18~ ~n~;~ 1427 ,
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