HomeMy WebLinkAbout0436 ~ i
Declaration ot Domicile a~d Cltizenshlp
TO THE STATE AND COUNTY TAX ASSESSOR. ~frO`! 73O
Sl. IUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and +
~n conformity with Chapte? 722, Section 222.17, Florida Statutes.
. 7- _
~ ~1~' .
y ~ _ _ - -
1 was formerl a I al ~esident of
~C;fy~ (State)
~y . Howrever 1 have chan ed m domitile
and I resided at ~ - - 9 Y
(Street and Number) ~ ~
da of ~
to and am and have been a bona fide resident of the State of Florida since - Y ~
!y ~ S ~
,-\J j` - - - . 19~l~_, and 1 reside at ~ ~ ~
(Street a~d Number) ^
FORT ~IERCE, SAINT LUCIE COUNTY, FIORIDA
and this statement is to be taken as my decla~ation of citizenship. actual legal residence and domicile in the State of Florida.
(Insert he~e any pe~tinent facts, such as sals of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
~
, ` J~~Q~ LL-~--K
~'Qi~'c'~
/ `7`2 2Q4530
FILEO AND RECOitO~
ST. IUCiE COUNTY F~.
ROCER POITRAS
CIERK CIRCUIT COIt1R
RECORD VERtF1E0~.~.
fEe 1 I ~ ~1 PM'71
~ ~
;
~
i
~
~
~
f
~ _
~
I FURTHER CERTiFY that I will comply with all other requiremenri of a leyal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domi4le, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
. ~
. _ , ~.C,~";J, G ` • ~G
~ t • ~ ~ = (Name)
~ - ~I~:~~,
~ . ~ ,
~ - ~ (Address)
~ • •lJt+,1.
'
Swom to and subxribed before me this _ day of ~ . 19 7~
~
~
~
~ ROGER rO1TR/1S
CIRCUIT CoURT Notary Public
~ ae.c.~I~GC~ ~P O~%~ 4
By D.C. My Commission expires _
~
~
(Ta b~ ~x~euf~d in dupliut~ and original fil~d with Cl~ric Grwit Court, and duplieat~ with Tax Ass~ssor.)
~
~ BOGK 130 4~5
r1o. 13
~ ` , -
~ t~ . ..._.a.. .,.,_a.. , , r-'