HomeMy WebLinkAbout1415 D~claration ot Domicile and Citisenship
TO THE STATE AN~ COUNTY TAX ASSESSOR. ~ 201369
51. LUCIE ~OUNTY, FIORIDA:
This is my declarotion of Domicile and Citizenship in the State of Flo~ida that I am filing this day in acaordance and
in conformity with Chapter 222, Section 222.17, Flo~ida Statutes.
1 was fo~merly a legal resident of _!l1_ 1lPS ~1 S S. .
~ (Ci~--- (State)
and 1 resided at -~i1?~~.5__ 1~R~,eR ~eu~fi Qio~( qN A__~t_$2. However 1 have changed my domiule
(Street and Number)
to and am and have been a bona fide ~esident of the Stats of florida since day of
--~~tU-~'- . 19~~, and I ~eside at G AR~I°N )1~ ~ U~
(Street and Number)
FORT PIERCE, SAtNT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration. of citizenship, actual legal residence and domicile in the State of Flo~ida.
(Insert here any pe~tinent fads, such as sale of prope?ty or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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Je~ ~ea N~ ~q y
y y r~EO ~wo ~ECoRpto
i~. LIICIE C4UMT~ fLA.
~ ROCEA P01TAAS
OLERII C~RCU11' 0 Rt
IIECORO YERIFiEO
~ Nar 1~ 8 ~o AM'1
~ 201369 ~
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I FURTHER CERTIFY that I will aomply with all other rsquirements of s lega) resident of this State.
I FURTHER CERTIFY that I have no intention b retum to my former domivle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
(Name)
7is G~RdeN~ a Ave
- c~?ad~~:~
Sworn to and subsuibed before me this day of ~ , 19~L~
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~iTRAs
1
:`C~Q`~~ . tCOURT Notary Public
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~ O.C. My Commission expi~es
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i~~ ~,,j.;~tw dYpticat~ and ori~inal Rl~d whb CIKIc Circuit Cou~f, and duplicat~ with Tax Ass~swr.)
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