HomeMy WebLinkAbout1301 . ~
~
Declaratio~ ot Don~icile and Citizenship ~
TO THE STATE AND COUNTY TAX ASSESSOR, 20~097
Sl. IUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and ~
~n conformity with Chapter 222, Section 222.17, Florida Statutes. ~
~
.e
I was forme~ly a legal resident of __~1 ~N~ 5 5 a- s
(City) (State)
and 1 resided at _ fi>.. a~ N~~ . Nowever 1 have changed my domicjle
(Street and Number) '
to and am and have been a bona fide resident of the State of Florida since _ l_ y ~
- - - - da of
4
:~'~~~~e~`~''~_ 19~~_. and I reside at s~~ _/,N~7'~1~/S ~Q N~_ _ _ `
(Street and Number)
i
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA i
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida. '
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc_) '
~
. ~r-
~
I
~Ea ~?~o P~coR~ta ~
~ucit couNtr t?.
RO~ER POITRAi ~
6LERK Gt8~U11 40 Q~
RECORQ YERif1E0 V ~
F~~ ~5 9 33 aH •1 i ?
,
~
T
' 20,)O9"7
f
s
~
~
~ -
F
~
~
~
~ I FURTHER CERTIFY that 1 will compfy with al) other requirementa of a legal resident of this State.
~ I FURTHER CERTIFY that I have no intention to return to m former domi 'le and I intend to remain in FORT
~ y G,
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~
~ ~ ~ ;
~ R;ch.sad (Name~_ /yiS,RM~N
~
~
;
(Address)
~
3 . p
~ Sworn to,a~d,s,~bscribed before me this day of , 19~
' C/
JQ ~r , . ~
~
~ R~~: • :~ou '
_
~ ~ ~ o Notary Public
~ 9y ~ ~ + ~ ~ ~ D.C. My Commission expires
~ ~
. :
~ ' ~~~T
~ ~•T .
s_
~ (To b~ ~x~t1~Ni~in•~lpliut~ and ori~inal fil~d with Chrk Circuit Court, and dupliul~ with Tax Ass~swr.)
tiy
~
o R ~SO i2~ `
~ e~~~
~ t.n 13
~
~ ~
~ ~ 3 ~y,
~ ~3`~... _r~,. . . , . . _ _'.a+