HomeMy WebLinkAbout1716 Declaration ot Domiclle and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FlOR1DA~
This is my declaration of Comicile and Citizenship in the Sta~e of Ftorida that 1 am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
Bnek~anaon w~t Vir~inis
I was forme~ly a legal resident of _ _ _ _ _ _ -
(City) (State)
and 1 resided at BOI 1, _ However 1 have changed my domiGile
(Street and Number)
ro and am and have been a bona fide resident of the State of Florida since l~,h _ day of
;
F~b~aa~7? , l9__ 71, and I reside at _ 134 _A~~t, Glea_!- ~
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my dectaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishme~t of employment
at former domicile, remova{ of family to new domicile, purchase of home, etc.)
Enteriag c6ildren in achool ~U
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f~lFO AND RECpp~~ ;
fL 1UCIE C011N~ ~
CLER~
CeJtqp~ OOItAT
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~ I FURTHER CERTIFY that I wil) comply with a!I other requirements of a legal resident of this State.
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~ I FURTNER CERTIFY that I have no intention to return to my former domi~ile, and 1 intend to remain in FORT
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~ PiERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ ~ • •r~ ~ - - (Name) -
a ' r; f c:.'%,• ? Jo~ae ( Yrs C6arlea ~ H~nlia~
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s; = "r ` 45.~ ~ G : .
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~ •{ti~;•. .,,1~~. (Address)
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~ .,'~S~tnG~~ark! subscribed before me this day of =-----1~l~h_ . 19-~1
y~ ' ..~~~~~e.•
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Y~ ROGER POITRAS -
~ , IERK CIRCUIT COU~RTs- Notary Public ~
~ - Q-c...C L~ GJ ch. lcl.L
- gy _ _ _ - D.C. My Commission expires
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~ iTo b~ ~xecuted in duplicat~ and originsl filed with Clerk Circuit Court, and dupliuts witb Tax Asststor.)
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s~190 i712
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