HomeMy WebLinkAbout1500 Declaration ot Domicile a~d Citisenship 20:~2`~ ~
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. WCIE COUNTY, FIORIDA:
Th~s ~s my declaration of Dom~ule and Cit~zensh~p in the Sta~e of Ftorida that 1 am filing this day in accordance and ;
k
~n conFo?mity with Chapter ?24, Section 224.17, Florida Statutes. ~
,
a
I was fo~merly a legal resident of ~~L ~ . ~ • ~
(City) (State)
4
OZf~ ~ f/~1/ T/y /~li~ /f~l~G~' $
and I resided at 7 _ _ However 1 have changed my domiCi~e ~
(Street and Number) j
to and am and have been ~ bona fide resident of the State of Florida since ~t G~ ~'d day of
~U~~ , 19_ 7~, and I reside at ~02Oi~ ~r. /~'q//YJ'f~/ ~L _ fT.
(Street and Number)
~ORT PIERCE, SAINT LUCIE COUNTY, FtORIDA
and this statement is to be taken as my declaration of c+tizenship, actual legal residence and domicile i~ the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removat of family to new domicile, purchase of home, etc.)
i
~
/~o n'!r ~J'T 9 D ~
~t'~ ~~o ~i
'o ~ `
r ~
20.j2-~3
~ FILEO ~•M~ kECOp0E0
! ST. R06cFC?~?i1AS~A.
~ CIERR Ct~CUIT COURT ;
~ aECO~o vE~+F~Eo
3 ~ I 9 s4 pM'T 1
~ ~
~
f
:
~
't
3 1 FURTHER CERTIFY that I will comply with all other requiremenis of a lega) resident of this State.
E
~
a
~ I FURTHER CERTIFY that I have no intention to ~eturn to my former domi~ile, and I intend to remain in FORT
~
~ ~ IERCE, SAINT LUCIE COUNTY, FIORIDA, permanently.
~
'r
~ 1
r a
- -
; (Name) ~
~ Jam ~DePuy ;
.f
~ ,
- C~-~`~--~~ `?7~
(Address)
Swom to and subsuibed before me this _ _1 S t _ _ day of _ _ _ _ _ _ ~rCh , 19 ~ 1
~
~ ~ ~~''~,'~i
r:
.
~
~ 1ir - - - - -
_ Notary Public
-
_ 8Y _ ~ - D.C. My Commission expires _
. f"~ ~i!. ~1+/ `
, ~ ' 4
4~ I + • ` ~
i~.-
~ ~ ~ ~I~ Jl V
;3 (To ~i'.;~1x '~n 'l~at~ and ori~inal fil~d with Cltrk Circuit Court, snd duplicats with Tax Assessor.)
~ e~RK1~U 14y"l ~
~ „
~
~
~ . _ . . . _ - _ _ . :