HomeMy WebLinkAbout2689 Declaration ot Domicile a~d Citize~shlp
TO THE STATE AND COUNTY TAX ASSESSOR, 208n~~
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51. lUC1E COUNTY, FIORIDA:
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This ~s my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
~n confo~miy with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of ~OnCY¢n7 _~-?T1Yrt~/Y -114-u~-~J~~-
(City) (State)
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and I resided at ~ L.R~C~erY T _~g~ v~__ However I have changed my domitile i
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(Street and Number)
to and am a~d have been a bona fide resident of the State of Florida since 9~Yu~I~'[ ~ 3_ day of
_ ~r4r?4!/~~ -t' _ , 19 7~ , and 1 reside at ~O~C .7Q0/t_ _ r~ .Iw,~~ AN K ~ ~r~ _ ~~e~_r P i
(Sfreet and Number)
~i~N KvNA, FiA~ :
FORT PIERCE, SAINT LUCIE COUNTY, FLORIOA
and this statement is to be taken as my declaration of citizenship, aetual legal residence and domicite in the State of Florida.
(Insert here any pertine~t facts, such as sale of property or business, or relinquishment of empioyment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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~G~Y,~7lJ~ClQGL .~,.S~..d~'yc ~b~i
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tILEO ANO RECp
i?.IUCIE COUNT~f
~ AOCER PO1Tll~i
QL.ERK CIRCylT C~,,,~C~~
RfCQRO YERIFIEO~~.~1
AtR 11 3a ~M'T I
208~~3
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~ I FURTHER CERTIFY that I will compiy with all other requiremant: of a leyal resident of this State.
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~ I FURTHER CERTIFY that 1 have ~o intention to return to my former domiCile, and I intend to remain in FORT ~
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~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ r-`. .iGY_1~- Si~~i_~Ti
~ (Name) K A ~ ~ C
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~ ~oX '!~'o~n ~
~ S~u r/? 1NQ''AN I ~!%E _ _ .
(Address) Fr ~p~E~ F~A•
_ 3.~ ~/3 0
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~worn to and subscribed before me this ~ day of - . 19~- -
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. . ~ CL~C1~f1~ CQURT Notary Public
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~ dy ' ` _ _ D.C. My Commission expires
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~ (To b~ ~x in dupliub and oripinal fil~d wifh C{~k Grcuit Court, and dupliut~ with Tax Assfssor.)
~ ,3 a~R~1g1 Z684
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