HomeMy WebLinkAbout0585 D~claratio~ ot Oo~nicll• and Cltis~nship
. #
TO THE STATE AND COUNTY TAX ASSESSOR. 202'711
Sl. lUC1E COUNTY, FIORIDA:
This ~s my declsration of Dom~cile and Citiz~~ship in tM St~ts of Flo~ida that 1 am filinq this dsy in ~ccordancy and
~n conformity with Chapte~ 222, Section 222.17. Floride Statut~t.
I wes fo~merly e leflal rosident of ~ vG ry M~ s S
~ (City) (St~t~)
end 1 resided at -!7a ~QL1~_~ However 1 have chanq~d my domitile
(Street a~d Number)
to and em and have been a bona fide ~eside~t of the Stst~ of Fiorida since ~~l~il`5,C ~ dsy of ~
~
_ . 191v, and 1 roside at y3~ ~~RD.~i~/ ~POR(! - ~cs~..f' ~Q~--
(Street and Numbe~) ,Q .
Ji~t-c c. ~-t
FORT MERCE, SAlNT lUC{E COUNTY, RORIDA ~
and this statement is to be taken es my declarotion of citize~ship, actual leyel ~esidence and domicile in ths State of Horida.
(Inse~t here any pertinent facts, such as sale of property or busineu, or relinquishme~t of employme~t
at forme~ domicile, removal of family to ~ew domicile, purchase of home, etc.)
~
c-Ct,• rt c~ l~rttl-QiGf~tc~'
~ ~
~ ~
j~lEO'~ Cp ~ .
~ Cl ~R~C RC01
REOORp ~~RIFI~j~
~ II ~ ~M'iI ~
t
;
~ .
~
~ 20~?~~
f
~
E ~
~
~
I FURTHER G'HtTIFY that I will oomply with all othar requiremenri of e(eqal resident of this State.
1 FURTHER CERTIFY that I have no intention to return to my former domicjle, and 1 intend to remain in FORT
~ PIERCE, SAINT IUCIE COUNTY, FLORtDA, permanently.
~ .y .
(Na )
- ~ w. yy;,~
~ F~-ad ~ti: c
a
s
~ (Address)
~
~ _
~ ~
~ .~ti~o.and wbscribed before me this '3/ day of /'e~ , 19~_sC.
jt~1 4'•
~ ~ 4:.
~ • J''v
~ ':~~<<)~' ~ys';~:
~ T '=~;~r .~i~'
~ : ' ~ ~tll~ ~OtlRT Notary Public
~ , : .
t - ~ t,: ~ / ~ -
~ a~~ ` ' y~ ~ .C. My ~ommission expires
~ ' _ ' ~
~ - (To b~t ...bciar/~i- in dupfiuh and orioinal fil~d wilh CINk Cirarif Court, ~ed dupllcat~ wilh Tax A~.)
~
~ ~ ~189 ~
~ 584
. . .
_ _ . ~ .
. .
~z. . _ _ - -