HomeMy WebLinkAbout0009 OeclaPatis~n ot Don~icile and Cititenship
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10 TFlE STATE AND COJNTY TAX ASSESSOR,
Sl LUCIE CQUNTY, FIORIDA
This ~s my detlarot~on of Qom~ciie and Cit~zenship in the State of Florida that I am f~l~ng this day in acco~dance and
n conform~ty wit~ Chapter 222, Section 222.17, Florida Statutes.
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I w~s f~rmerly a legal resident of ~CT~UG~~Z ~
(t;~y) (State) ~
a nd 1 resided at t~-~ ~ U( it.~ However 1 have changed my domiCil4
(Street and Number)
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ro and am and have been a bona fide resident of the State of F!orida since L / day o~
_ , 19~~ , and 1 reside at ? ~f!- ~~~.____1Sl~_~_S~ - - - '
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FL~3RIDA
and tnis statement is to be taken as my declaration of citizenship, actual legal residence and domicile sn the State of Flo•ida.
(lnsert here any pertinent facis, such as sale of property or busir.ess, or relinquishment of emp;•~yment
at former domicilE, remova! of family to new domicile, purchase of hom~, etc.)
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~ I FURTHER CERTIFY that I will mmply with all other requirerr.ents of a legat resident of this State.
I FURTHER CERTlFY that t have no intentior to return to my forner domi~ile, and 1 intenu to remain in FORT
~
~ ~!EkCE, SAINT LIiCIE COUNTY, FLORIDA, permanently.
FREDERICK W. THIE NN, JR.
,G i` , ,b~~.
c-L tc ~ _ l~ ~lu~,-~-t-A--.~-~ ~ ,
' - • - . f - ~Name) - -
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~ - a~ . - , t~/O,-S'~ ~ N .c. ~r _ ? ! c XC ~ {
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~ Swcx.~ to and subscribed before me this _ l_____ ~ _ _ day of _ ~ _ _ . 19~_~ 4
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: ROCER POfTRAS - - ~
~ CLERK ClRCU T COURT Notary Public ~
~ BY - ~y _f~~- - D_C. My Commiss~on expires ~ _ -fr~-.r , _ `
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~ (To be ~xecutsd '+n duplicate and original filsd with Cleric Grcuit Court, :nd duplicat~ with fax Qszcssor.)
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~ B~~K 194 9
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