HomeMy WebLinkAbout1735 I~rQa~ V a~ ~Z
DeCla~atio~ ot Domicile and Citisenship
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TO THE STATE AND COUNTY TAX ASSESSOR, ~
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Sl. WCIE COUNTY, FIORlDA i
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Th~s ~s my declarahon of Dom~cile and Gtize~sh~p in the State of Florida that I am filing this day in accordance and -
n conformity w~th Chapte~ ??2, Sect~on 222.17, Fiorida Statutes.
NEcv TE/L,f E~
1 was forme~iy a lega! ~esident of A L D w f L L_r _
(City) (State)
and 1 resided at ~ 3 S M vLL i4UE_ However 1 have changed my domiCile
(St~eet and Number)
~o and am and have been a bona fide res+dent of the State of Florida sirxe ~ G%
o~t1f~L _7 T~ day of
- - . 19_7~, and I reside at ~ a~ N~, T~lIV /.j'D~/ A~ E .
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Flo~ida.
(Insert here any pertinent facts, such as sale of ptoperty or business, or retinquishment of employment
at former domicile, remova! of family to new domicile, purchase of home, etc.)
205394
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€ I FURTHER CERTIFY that I will comply with all other requiremenis of a legal resident of this State.
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~ I FURTHER CERTlFY that I have no intention to ~eturn to my former domiGle, and I intend to remain in FORT :
~ ~IEitCE, SAIN7 LUGE COUNTY, FLORIDA, pe~manently. ED~YARD RAND T,
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„ ' ,..-,:r , (Name)
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~ Swom, b and wbscribed before me this • day of , 19~_.
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~z ROGER POITRAS
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~ CIRCUIT C RT Notary Public
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~ 8y ~ _ D.C. My Commission expires
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~ (To b~ ~xscuted in dupliut~ and oripinal fil~d with Cbrk Grwit Court, and dupliuts with Tax Ass~ssor.)
~~y ° ~ 190 ~731
;4 600K
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