HomeMy WebLinkAbout2649 Declaration ot Domicile and Citisenship
2osco7
TO TNE STATE ANU COUNTY TAX ASSESSOR,
Sl. WCIE COUNTY, FIORIDA:
~
i
This ~s my declaration of Dom~ule and Cititensh~p in the State of Florida that 1 am filing this day in accordance and
,n conformity with Chapter 2~2, Section 222.17, Florida Statutes.
. ~
I was formerly a legal resident of f_ ~~1L_ __.fr _ L~•U ~
(City) (State)
~ ~
and I resided at ,~d ij ~~tf-t~4-~t'~~ ~~1'~_ However I have changed my domiGle
(St~eet and Number)
~o and am and have been a bona fide ~esident of the State of Flo~ida since day of
- `~j~~ , 19 , and I reside at TG~_ ~~_~u-s/
~ (Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citiienship, actual 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 ~ew domicile, purchase of home, etc.)
. , ~ ~ • 2 U ~ 0 0 7
c,~~~~ ,
~ _,~~..~~E
r~~~
+t~coR~ rER fi~o.,~~~
M~ 11 2 ~ rl!' ~
~ . _
~
~
i
S
f
e
~
6
i
2
~
4
~
~ I FURTHER CH2TIFY that I wili comply with all other requirements of a leyal resident of this State. '
~ i
~
~ 1 FURTHER CERTIFY that I have no intention to return to my former domic,ile, and I intend to remain in FORT
~
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently_
~ ~
~ __,;:,,''~;;~~x: ea:.`• - s < < ~ , ~~~i ~ 1 ~ ~ ~ .~d
~ ~ , ~ - ~
~ l~ ~~b' ~G,. J~ (Name)
\ : ~~~'~+s~' - s _
:t 1~+ F~;~- . f - ~ ~
_ ~ 3,~~~~c._ -
; A~ ~Y ; /
_ M~~ ~
~ t ~ ~,;-`~.t~' t ~
•,Q'~; -
~ ~ G ` ~ ~
.x Swo~n.te`and subxribed before me this l"~ day of , 19~_.
~
~
r ROGER POITRAS _ _ ~
CIRCUIT COURT Notary Public
~q f
~
~ ~
~ Sy D.C. My Commission expires
~
~
~
~
(To b~ ~x~cut~d in duplicat~ and oripinal fii~d witi~ Ckirlc Grcvit Courf, and duRlicat~ witF~ Tax Ass~ssor.)
t.4
„ a~o~ lyU z645
-
~ . _ . .