HomeMy WebLinkAbout2699 Deciaration ot Dort~icile and Citisenshlp
TO THE STATE AND COUNTY TAX ASSESSOR, IGrVVOSO
Sl. LUCIE COUNTY, FLORIDA:
This is my decla~ation of Oomicile and Citizenship in the State of Florida that 1 am filing this day in acco~da~ce and
~n conformity w+th Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal r~sident of e/_~ "
Q - - j
(City) (State) s+
1
l~' ~ G? Y ~ r However I have chan cd m domitile '
and I resided at - - - - 9 Y
(Street and Number)
~ l _ _ - - - day of t
ro and am a~d have been a bo~a fide resident of the State of Florida since ~ `
r~ l - . 19~ l-. and I reside at -TC! N i S o f~! ~d e----- -
~ (Street and Number)
EORT PIERCE, SAINT LUCIE COUNTY, KORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State ot 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.)
~ ~r-t ~r~~ ` /
~ C'f~i~la~~~7 .h ~Sckao~
CONNIS Z. I~IZI,TsR age 13
I,ISZ Z. IAILLER ag~ 9
FILEO AND RECOR~EQ~ !
ST. LUCiE COU1tTY tA. ~
ROCEtI POtTR~i
CLERI~ GIRCUIT COUII C
RECORD YERIFIED~~
Ar~ 22 II 2z AM'~ 1 s
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s
F
i
~ 208050
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~ ! FURTHER CE#iTIFY that I will comply with all other requirements of a leyal resident of this State.
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~ I fURTHER CERTIFY that 1 have no intention to return to my former domiule, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIOA, permanently. ROBER~ P. jl1I.L~ 1
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~ , , ~ ~ ~ ~ r ~rrr~~~ (Name)
~ ~ J i i ~ir .
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= s.. ' ~-ti -•f.: p~.rl~ (Address) ~
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to'-a~d ~~~~icd before me this nd ~ day of ` 19~.
; ~ .
~,'z _ ~ ~ J ' .
ri LJ: ~ •
'K
`z ROGER POITRAS
CLFRK CIRCUIT COURT Notary Public
By - O.C. My Commission expires
s.z i
~
~ (To b~ ~x~cuNd in dupliut~ and ori~inal filsd with CIKIc Grcuit Court, and dupliuf~ with Tax Ass~swr.)
° R i91
~~o. 13 8~i1~ rw
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