HomeMy WebLinkAbout0902 - 2(~2~2~'
O~cla~atlon o~ Danicll~ and Citis~nship
TO THE STATE AND COUNTY TAX ASSESSOR,
Si. LUCIE COUNTY, FIORIDA:
This is my decla~etion of ~omicile and Citisenship in ths Stete of Ftorida that 1 am fili~p thit d~y in aooordano~ and
~n oonformity with Chapter 224, Section 2~2.17, Florida StNutes.
I was forme~ly a legel ~esidemt of ~~f'l/i/ ~•~r
(Ciy) (St~b)
and I resided at --5~~'~Lt~-•1,ti~ QN~e. However 1 have chanqed my domidle
~ (St~eet and Number)
to and am and have been a bona fide ~esident of the State of Florida sinte l dey of
' - . 19~l2, and 1 roside at ~u-~.~ •Y1-t.~~`e-
(Street snd Number)
FORT ~IERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is ro be taken as my declaration of citizenship, actual legal residence and domicile in the Stete of Horida.
(Insert here any peninent facts, such as sale of property or business, or ~elinquishment of employment
at former domicile, removal of family to ~ew domicile, purchase of home, etc.)
~ ~ iT.ld~iE COW11Y f'1~
RO~ER PWTitAs
RE~D
~ER
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EO a~T ~
5 1! ~~.AM'11
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1 FURTHER CERTIFY tfiat 1 will aomply wiffi all other rsquiremereh of s Ispsl resident of thi: State.
I FURTHER CERTIFY that I have ~o intention to return to my former domic,ile, and I intend to remain in FORT
PIERCE, SAINT IUCIE COUNTY, FLORIDA, pe~manemly. Jean DeKeulenaere
(Name)
~/~r` o~~~ ~~t..
~ (Addres:)
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~ Sworn to and subxribed before me this 5 th day of J anuary ~ j9 7I
~ R ~ ~ ~ 'f~?~~~
L'~K~1RC~~ Notary Public
~ c~~R.•dP.
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:
By ' O.C. My Commission expires
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tTd~}~•~•
~ie
duplicat~ ~~d oriainal Al~d whb CIKIc Ciraiit Coutt, aed duplicsf~ wi~h Tax A~~ra
g~• -
~oK189 ~~E 899
No. 13 _ . - , . .
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