HomeMy WebLinkAbout1665 Declaration ot Domicile ~nd Citizenship
TO TNE STATE AND COUNTY TAX ASSESSOR, r~`
t, ~A~
Va3
Sl. LUCIE COUNTY, FtORIDA
Th~s ~s my declaration of Dom~c~te and Gh2ensh~p in the State of Florida that I am filing this day in accordance and
n conformity with Chapter 22?. Section ?2?.17, Florida Statutes.
i
. ~j ~
I was formerty a legal res~dent of ~c~~t _ -L~ ~i~_ _
(City) (State)
and 1 resided at / ~
. ~ _ However 1 have changed my domic,ile
(Street and Number)
•o and am and have been a bona fide resident of the State of Florida since day of
, 19 ~C~, and I reside at ~-~__1~--~-~" _
~ (Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIOA
a~d this statement is to be t~ken as my declaration of citizenship, actual legal residence a~d domicile in the S!ate of Florida.
ilnsert here any pe~t~nent facts, such as sale of property or business, or relinquishment of employment
at former dornicile, removal of family to new domicile, purchase of home, etc.)
~,r ~
~ ~7nE~ f~ Eo ~Np `
iT 1iCFE COUN~~~
~~ER°~c~c
Rc tiu'=
REC~t~ ~ER~FI~j
e~
~
M~ 1 I I s9 AM't I `
;
~
~
~
2~
,33~ ~
~
~
s
~
~
r
~ 1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
~
I FURTHER CERTIFY that I have no intention to return to my former domiGle, and I intend to remain in FORT ;
PIERCE, SAINT IUCIE COUNTY, FLORIDA, permanently.
~ j
~
~ ~~Y~ ~ - - ~
~ (Name) ~
~ ~~~~F~
~ ~~~~~~.C
(A dress) G1~
~ ;
~
~ ',gwq!n fo and suburibed before me this ~~e _ day of G.~~r c1-~- • 19~ ~
~ = ,
.
- • .
~ .
: • -
s _ ; ,r-•~ , - ~7•~.-. _
~ .
~ ~ ~ • i ~ '~`M~• ~ '
; ~ ' _ - . ' . - ~ - -
~ 1 C~ItCfil~ COURT -
~ - ~ _ _ Notary Public
: .
. ; `r:-
s ~ < < . l, " ,
_ .
y ~y €
~ Bj~'- . ~ _ _ _ _ D.C. My Commission expires _
, .
.1 , t
~ - ~ ~ }
~ "n•.....i; t'-'~y
~ -
(To 1» ~x~crNd in dupliuN and ori~inal ~il~d with Cl~rk Grcuit Court, and dupliuN with T~x Ass~ssor.)
a~~~ 1~o sssz
~
; 3
_
,
~ , - -
_ _ _