HomeMy WebLinkAbout0208 Y'
D~claration ot Don~ici!• and Citiz~~shlp
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TO THE STATE AND COUNTY TAX ASSESSOR, ~
Sl. lUC1E COUNTY. F~oR~oA: 2~2461.~ .
This is my declaration of Domicils and Citizenship in the Stats of Florids that i sm filinq thls day in aaordsnce and
~n confo~mity with Chaptar 222, Sectio~ 222.17, Florida Statutei.
I was fo~merly a tegal resident of ~N L~~ L~ _ ~r ~ _
. (CifY) (StaM)
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and 1 resided at _~~!~l ~ r ff'~ ~~~J However I have changed my domic3le
(Street and Number)
to and am and have been e bona fide resident of the State- of Florida since - ~ C_-~ day of
- - - 1970 , and 1 reside at ~ ~•A~' G r L ST
(St~eet Number)
- p,~Gt~~t .
FORT PIERCE, SAINT lUCIE COUNTY, RORIDA
and this statement is to be taken as my decla~ation of citize~ship, actual legal residence and domicile in the State of Horida.
(Insert here any pertinent fads, such as sale of p~operty or business, o~ relinquishment of employment
at former domicile, remova) of family to new domicite, purchase of home, etc.)
' ~-sy G
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? LEO AM@ RECOROEp
f~. WCIE COUNTII fLA.
ROCER POITRAS
CLERK C~RCUIT COURt
RECORO VERiFIED
O~c 13 2 2i PH'70
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' 2a2461~ .
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I FURTHER CERTIFY that 1 wil) comply with all other requiremants of a le~al residsnt of this State.
I FURTHER CERTIFY that I have no intention to return to my former domiCile, and I intend to remain in FORT
~ PIERCE, SAINT LUCfE COUNTY, FLORIDA, permanently. '
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~ (Name) /
~ ~Q t?- r C I< 1fl'~ ` Gc~ /j ~
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~ (Address)
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~ __~~~Jvor~tti,qnd suburibed before me this day o ~f s-~~~-- , 19~•
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~ :r ~ ~~Ii',t .~r 'j =
~ . ~ ~°'•~~~~CO J Notary Public
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~ '$~i 0.C. My Commission expires
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Re lfi,~ ` in duplfuh and ori~inal fit~d wifh Cl~rk Grwk Cour1, and duplicN~ with Tax Ass~swr.)
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