HomeMy WebLinkAbout2495 _ ~ .
Declaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
20'7946 7
Sl. IUCIE COUNTY, FLORIDA:
This ~s my declaration of ~omicile and Citizenship in the State of Flo~ida that I am filing this day in accordance and
~n conformify with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal ~esident of _ 1?~~I~ V. ~ J!. _ r L-- -
(C;ty) (State)
and 1 resided at _ However I have changed my domitile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _ day oi
- ( / ~ ~ , 19 f, and I reside at ~ - ~ ~1 _ '
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, HORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domiciie in the State of Florida.
(fnsert 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.) ;
1
~E,~ , ~v~ c y~ ~ ~ ~ ti ,
~ ~ ~ ~ ~~a ~
s~~a ,~~.-z-a-~
~ /1LED 1?NO RECOit~Eo
iL LUCIE COUNTY LA. ;
IIOCER POITIlAS '
CLERK CIi1CWT COUIIT
RECORQ VERIFIEC~
ArR 19 IZ i2 PM'11
. 20`7~Q6
~
;
F ~
t
~
1
~
S
t
~
` I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
~
~
~ I fURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT
~
ti PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently_
~
.
~ ~ ~ ~ .
~ - -
' /Yf/qIQiE (Name) ~l.~,~i/l~
~
~
~ : ~o ~ S ~ c ~ ~ ~ - -
- ~ (Address)
~ . -i!",' ~ . . . - 4
h • Fs % ~ q
f ' ~e'r •5wo%t* !o and subscribed before me this _ - day of - , 19 ~ / .
- ~ : . _
~
' ' .°~ER POITRAS _
f; ' CLERK CIRCUIT COURT ; Notary Public
Y ^
f ' ~i J~L .
By - ~.C. My Commission expires
qi L ~
~ ~
~ ~
(To b~ ~xecuted in dupliwts and oripinal filed with Cl~rlc Grcuit Court, snd duplicat~ with Tax Ass~sso~.)
~ 1 ~1 2490
~
- - -
_ .