HomeMy WebLinkAbout0933 ~
. y
~
Declaration ot Domicile and Citizenship
2068Qg
TO THE STATE AND COUNTY TAX ASSESSOR, ~
Sl. IUCIE COUNTY, FLORIDA:
This is my declaration of ~omicile and Citizenship in the State of Florida that I am filing this day in actordance and
~n conformity with Chapter ~22, Section 222.17, Florida Statutes.
~ ~ /
I was formerly a legal ~eside~t of _<<«~~~ _ `~~t"~
_ ~ ~ -
(City) (State)
~ ~ ~
` ~ ^ i
and 1 resided at _ _~rG~~Gt~r~~-^___- However 1 have changed my domicjle
(Street and Number)
Ta and am and have been a bo~a fide resident of the State of Florida since _ _ day of
~ - , 19~~, and I reside at SL'_ ? ~~lv~' (.G ~G-~-~LC..+~:~ ~
Street and Number) ~
~ i
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
i
and this statement is to be taken as my declaration 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 relinquishment of employment
at former domiciie, remova! of family to new domicile, purchase of home, etc.)
,~l pysz~ ' ~ fL
f
,
~l~BflK~~~ RD!'6p~ :
~ ~
~
z06848 ~
F
t
f
~
F
i
!
~ 1 FURTNER ~ERTIFY that I will comply with all oth$r requirements of a legal resident of this State.
F
P
; 1 fURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
~ PiERCE, SAINT IUCIE COUNTY, FLORIDA, permanently.
~ ~ - ,
~
: t ,
(Name) ~
~ /~~c_l p~+ ~'h ,~~y r- r- d
~ - -
f; (Address)
r Swosn to and suburibed before me this day of _ , 19~~
; ~
~ . t,
, ~
~ ~..•y.--~.
~ y , .
-,co~rt-~omu?s - - ~
~ ':,T_f ~ ,fclRC~COURT Notary Public ~
_ ~ ~ i ~
'r BY _ L..~ D.C. My Commission expi~es
~ .i, '
~
~ - ~ G.~ ~
; "(Ta~~t ~x~cuted in dupliut~ and ori9inal ~ilsd with Cl~rk Urcuit Courf, and dupliut~ with Tax Ass~ssor.)
4~
ti r~- ,3 800K
~ ° R 191 y32
~
_ _
_ ` , ~ -
. . _ . _ -