HomeMy WebLinkAbout1418 Oeclaration ot Do~nicile a~d Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR,
51. WCIE COUNTY. FIORIDA:
- This is my declaration of Oomicile and Citize~ship in the State of Florida that I am fili~g this day in accordante a~d
~n conformity with Chapte~ 222, Sectio~ 222.17, Florida Statutes.
,
;
I was formerly a legal ~esident of ~~/O~ ' C~<v -
(Gty)~----- (State)
and I resided at 1~~}~_~~G However 1 have changed my domici~e
~ (Street and Number)
to and am and have been a bona fide ~esident of the State of ftorida since _~OV day of
-_.~Q v- . 19~~ and I reside at 1G~ ~
(Street and Number)
FORT PIERCE, SAiNT LUCIE COUNTY, KORIDA
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 pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.) ~
.
v e~v~-~r I'~ ~~i ~/dr ~.v ~ ~v : s ~Lio
~ y
2013`72 . ~
i1lEp AN~ RECpR~E~ ~
LUCIE COUMT1f /LA. !
RGCER POItM:
CLERK CIiiCUl~ 00{t~T ~
ItECORD YEII~FIEd....~.~
~ Z~I ~0 Ol ~M ~
d~
~
~
~
~
~
~
~
~ ~
~ ~
I RIRTHER GERTIFY that I will oomply with atl other requirements of s le~al resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domiGle, and I intend to remain in FORT
PIERCE,~_SAINT LUCIE COUNTY, FLORIDA, permanently.
,r:~~~~u:u:i:;; . ~
``~~~V~'~~ N~~j~~v,r~J% - ~ ~~'I~~1~~''w / .
• 1~~R c 0 . Q•• ~%~ccG~-
1 ~
? C
~ gJJ~ cG~ ~ (Name)
. i: . rr'~'• ~ OGS .
.
E ~p~~t~tz
=_'~i~" ` ' • ~~:_Q _
s ; Po-~~~~X ~li~
~ , ,1-r'~ ~
~ ~ - ' - (Address)
'•.h..... `
. f U~ c E'~:` ~
' ~ ~ ~ ~~~~ti`~~;~S+c ~ , /
Sworn to'~bnd suburibed before me this ~f day of ~~~~j~~''~ , 19~~. ~
~
ROGER POlTRAS
CIRCUIT COURT Notary Public
By D.C. My Commission expires
(To b~ ex~cut~d in duplicat~ snd ori~inal fil~d with tl~rk Grcuit Cour~, and duplicah with Tax Assesior.)
„ sooK188 ~~1415
- - ~
~~~a~~ ~~.~;x~~
..ti;
~
- ..l~:`~-