HomeMy WebLinkAbout1672 ~eclaration ot Don~icil• and Citis~~ship
TO THE STATE AND COUNTY TAX ASSESSOR. ~
Sl. LUCIE COUNTY, fLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing thi: day in aooordance and
in. tonfo~mity with Chapter 224, Sectio~ 222.17, Florids Statutes.
I was formerly a legal ~es~dent of - Stroudsbura Penn
(CitY) (State)
and 1 ~esided at 45 Garden 3tt6ot Howevef I have changed my domitile
(Street and Number)
27th
to and am and have been a bona fide resident of the State of Florida since day of
-.1~~p.v~m~ez_ , 19
?.Q, and I reside at II-V18t8 Court 8d. 1 Boz 904
(Street and Number)
FORT PIERCE, 5111NT WCIE COUNTY, RORiOA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
(Inser~ here any pertinent fads, such as sble of property or busineu, or relinquishme~t of employment
at forme~ domicile, removal of family to new domicile, purchase of home, etc.) -
Satablishing reeidence and entering Brett in the 2nd grads
2Ci565 ( Brett Henning) _ _
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CIE COIIN`T~ I~A.
ilQQER PpIT
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~CORO YERi~f
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I RJRTHER CERTIFY that 1 will oomply with all other requirements of a(e~at reside~t of thia State.
1 FURTHER CERTIFY that I have no intention to retum to my former domicjle, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
;~~~`ti~itllt:!:~y~,_ u~. . ; _ .
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: ~~~t (Name)
; ;
xuth Ann Goucher Ha zen
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: ~ 4~~. ~ . (Address)
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. , s~lfi'su~bscribed before me this 30th day of 8ovemb~r ~q~,
•
ROGER rOtTRAS
CIRWR COURT . Notary Public
B a'`'f`'~'' D.~. My Commission expiros
Re b~ ~x~arNd 1n d~iplicab aed ori~inai Al~d wilh Ckek Ci~a~if Co~~f, aed dupliat~ writh Tax As»~xa
- ~ aoK 188 ~~E16fi9
No. 13
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