HomeMy WebLinkAbout1761 2U,~411
Declaration ot Domlcile and Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FIORIDA: '
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This is my declaration of Domicile and Citizenship in the State of Florida that 1 am fil~ng this day in accordance and i
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~n conformity with Chapter ?22, Sec?ion 222.17, Florida Statutes. ~
I was formerly a legal resident of ',Jl~'S'!~!G'~~~'~ a `f `1---
(City) (State)
and 1 resided at o~ 3. ~X~~_~f~'~~ Q.-_ _~ti~~ _ Howeve~ I have changed my domicjle
~ (Street and Number)
to and am and have been a bona fide resident of the State of Florida since /--~j~. _ day of
_ _ ~ l~J~ , 19
~ ~ , and I reside at /F L 1~~E'_~_~A ~ ST~f ~ .C ? 1~_ _ _ ~
U (Street and Number) ~
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FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actuai legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.) '
~ .y.C •.f~,~,4' EX~•~! ~°T~oiti
. 2O
~411
fIIEG AMD R C
;T ROCE~ P01T~
ItEC01tQ YER%1~p ~~t
M~ 3 { OS rM'TI
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~ I FURTHER GERTIFY that I will comply with all other raquirements of a legal resident of this State.
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~ 1 FURTHER CERTIFY that I have no intention to return to my former domic,ile, and I inte~d to remain in FORT ;
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. i
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(Name) ~
~ Joseph Peck ~
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/ C L,.~ /~iP/MA 1~_ i ~j rA ~.l V ~ {
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ni (Address) ,
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Swom to and suburibed before me tfiis 3rd day of March ~ ~9 71
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R06~R~P{3t~~fA6- ~ i
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~ tIREV1T 's Notary Public
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~ 8y D.C. My Commission expires
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Ro bt ~i1NBFii•~tab snd ori~insl filed wifh ClKlc Grcuit Cou~t, and duplicat~ with Tax Ass~s~or.)
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