HomeMy WebLinkAbout0915 1
~c1uallon ot Domiai!• and Clt~~nshlp 2(12~3,~~
TO TH~ STATE AND COUNTY TAX ASSESSOR, `
St . LUCIE COUNTY, FIORIDA: '
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This is my detlaration of Oomicile •nd Citisenit~ip in tht Stat~ of Florida that 1 am filirp thi= d~y in aooordano~ and
~n oonformity with Chapter Z24, Sectio+~ 222.17, Fiorida Statut~s. ~
1 was formerly a legal reside~t of ~~r~.Q~~-~-~- • -
(City) (S h)
and 1 resided at L D. E' y~~,~ /C.d Howevar 1 have chsn~sd my domidle
(Str~et and Number) .
`
to and am and have been a bona fide resident of the State of Florida since day of
, 19.~Q, and 1 roside at ~ 1 - -~r '
(Street and Numbef)
FORT MERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legai residence and domicile in the State of Florida.
(Insert here .any pe~tinent facis, such as sale of property o~ business, or relinquishment of employment
at former clomicile, removal of family to new domicile, purchase of home, etc.)
202~35
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~uciE $aiNTir~.
QOOER POIT~A=
C~EIIR CIRC@1T OOIMt
- REt~It011ERIFIED
~r 5 2 is PM'T!
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~ 1 FURTHER CEitTIFY that I will aomply with all other requirement: of a Is~al residsnt of this Stats.
1 FURTHER CERTlFY that I have no intention fo return to my fo~mer domitile, and 1 intend to remsin in FORT
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~ PIERCE, SAINT LUCIE COUNTY, FlORI~A, permane~tly. jo,r,.
p~ G. lloo/+mon
(Name)
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~ ~ / S l!/, 3 9-~
~ , (Address) ,
~ F°~',~°,,c,ti„u J F.~l~
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~ Sworn to and subscribed before me this ~ dey of , 19~.
~ ~ r:•1j~~
~ • ;
~~~~~~w~'~;
Notary Public
~ . , ; _
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~ By ~ ~ D.C. My Commiuion expires
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~ ~ ~ • ~
~ Rs~j ~il~ i~,~plica~a and orioiwsl fil~d wilh Cl~ek prarif Co~e~, and dvplkah wMl~ Tax As~o~.)
~ ~'~i~au~~~+:~~~t
~ ~ ~ BooK 189 PAGE 91~
~ No. i 3 - - - -
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