HomeMy WebLinkAbout1628 DeCla~ation ot DomiCile and Citizenship ZU5319
TO TNE STATE AND COUNTY TAX ASSESSOR,
51 lUC1E COUNTY, FIORIDA
Th~s ~s my declarati~~ of Domic~le and Gtizensh~p in the Staie of Florida that I am filing th~s day in accordance a~d
n conformity wrth Chapter 222. Secr~on ?22.17, Florida Statutes
I was formerly a legal res~dent of '`Q v~~~ti
(City) (State)
and 1 res~ded at t n~~4 S.. ~1 Q~' However 1 have changed my domiGle
(Street and Number)
•o and am a~d have been a bona fide resident of the State of Florida since ~~y I S~ day of
~~1 , 19 , and I reside at ~~5- S' W• ~4~~. l.]r• ~'S~ ~
~ (Street and Numbe~) '
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA i
and this statement ,s to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida. ;
3
(Ensert here any pert~nent facts, such as sale of property or business, or relint~uishment of empfoyment i
a
at former domicile, removal of family to new domicile, purchase of home, etc_) ~
- i
~eb v~e C~ ~S ~~c~er ~t~ a~-~i~-c~ ~ .
~
F~. Q a e.?~ c~ ~C, o ~ e. ~ a~. -Q„
v~ ~ .c ~ c..~ S ~ r c ~ o~t-~ C~ ro-~.r~ G - • C , ~
f
205313 ~
$
~
f LED AN9 IIECQ,II~~ ~
t~. LUCIE COUNTT ~
G~ ~ ~ocEa ro~rn~s #
/ CLERI~ CIRCUIT COilllT g
RECORO YERIf1E0
M~ 2 9 Sl AM'~ ~
`s
~
~
i
~
4
~ '
P
~ 1 FURTHER CERTIFY that I will comply with all other requirements of a legal reside~t of this State.
~
~
~ I FURTHER CERTIFY that I have no intention to return to my former domicjle, a~d 1 intend to remain in FORT
~
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
e
~ ~ ~
- D.a. :
~
(Na tN i BI~i tr . LU i&~% ~
~ ^
~SS =S_~ • ~0.~ !i.~,r ---~5 L .
- (Address)
~
y.
3 Swom to and subscnbed before me this __~t1~ _ day of ._±!~a= lq-~i.
.1:..,.~. ,
Z ~
` R~'~" ' - - - - -
Notary Public
- ~ . -
vt ~ • ~a"' . ~ti~' ~ _
y , - D.C. My Commission expires
, ~,',.-'.~~~Y' ~y .
~.y ~
_ ~r ~ ~ rJ'~ ~ V _ _ •
. •
a~`i'~ ' -
:r;~ Ro br ~ic~~~ ,t~ and ori~inal fil~d with G~rlc G~cuit Court, and dupliutt with Tax Ass~ssor.)
-
-:<<,~~~:,,..,:~~ r R~ i~0 ~625
~ - 1~C
~3
:
~ r
- 'r~~.
_
~~~a „ ~ ~ _ . - _ , _ _