HomeMy WebLinkAbout0719 Qecla~ation o! Domicile ~nd Cltlsenship 212862
f0 THE STATE ANU COIf:+'.Y TAX ASSESSOR, ~
Sl IUC~E COUNTY, FIORIDA ~
Th~s ~s my declarat~on of Dor.i~ule and Cihzensh~p in the State of Flor~de that 1 am f~l~~g th~s day in eccordance and
n conformity with fhapter 22?, Secticn 22?.17, Flo~ida Statutes ~
~ was forme•1y a Iegai res~dent of HICNSYILLx _ T~? Y0~ _
~C;ty; (State)
and ! ~esided at 1 LOCLi8t Street However I have changed my domicjle
(Street and Number)
~o and am and have b2en a bo~a fi~e resident of the State of Flo~ida sir~ce 5th . day ot
. Jul~ .~v_71 , and I rPSide at . 3~8 S. _Trenquils A~e.
(Street and NumberZ
Port 3t. Lucie Fle. 33450
FORT PIERCE. SAINT LUCIE COUNTY, FLORIDA ~
and this statement +s to be taken as my declaration of citizensF~ip, actual legal resiclence and dorr,icile ~n the State of Florida.
(Insert here any pert:~ent facts, such as sale of p~o~erty or business, or relinquishment of employment
a! former do-niule, removal of family to new domicile, purchase of home, etc.) i
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21;~86;~ ;
RES IDFNCE ST~IUCiE ~ OUMTY fLA.
1lOCf R P01tRAS
CLERK C~itG~JIT COURT
RECORO VERIFIEO~.~.
Ju~ 16 3 ~a rN'~! ~
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I FURTHER CERTIFY thaf 1 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 domi~ile, and I intend to remain in FORT
?!ERCE, SAINT LUCIE COUNTY, FLORIDA, permanently ~ERRA~ L. RO ,
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~ , _ : : (Name) ~ :
~ n0 f
b i
~ • ;26 S.E. Tranquill~ ~r~., '
~ . ~ - a ~ - - Add~ s~ - - _ - - ~
~ ; Port St. ~ucie, Floride 33450
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~ ~Aoif*'t~;~. -1~subscribed before me this - . 26th _ _ day of _ _'T~~ 19__?~
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RO~iER POfTRAS - `
~ K CIRC T C URT Notary Public -
~ 8Y - _ _ ~ _ !~!~_-±'VS-- D.C. My Commission expires . -
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~ (To bs ~x~cuted in duplicats and ori~inal fil~d with Cl~rk Circuit Court, and duplicat~ with Tax Ass~ssor.)
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~ 4~°~ 194 7'19
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