HomeMy WebLinkAbout2611 DeClaration ot Dort~icile a~d Cltize~ship 21~152 '
~
TO THE STATE AND COUNTY TAX ASSESSOR,
- ~
Sl. LUCIE COUNTY, ~LORIOA~
~
This is my dectaration of Dom~cile and Citizenship in the Stare of Flo~ida that 1 am fi~ing this day in accorda~ca and
~n conformity with Chapte~ 222, Section 222.17, Flo~ida Statutes.
1 was formerly a legal resident of ~/~i L O~v/L ~ O~l~ !
-(Cityl (~tate)
and 1 resided at . 30 7~ ~C~N _ Howeve~ I have changed my domicjle
(Street and Number)
7~
ro and am and have been a bona fide resident af the State of Flo~~da since - - day of
~v L~ , 1971 , and I reside at !P r~ _ Q_~
X 6~/S f T_P1E~cE F~A
(Street and Number)
FORT 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 of Florida.
(Inserr here any pertinent facis, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
bR n/~E L c/. ?'o u. El/ S o n/ - 6 T~.
T~~M~T~~ To w Fy so~v - y rw
a Ro
o Gc. Ec - T~ w~`~ 0~3 ~ c~TE~2
i
214152
FILFD ANI+ RECOR Ep
ST, IUCIE COUMTY ~l~
ROCER POtTpAS
''i CtER1[ Cl~Ct11T COfIRT
R~CCt10 VERiilEO
t
I ~ ~UC 2 19 ~'7~ `
I FURTHER CERTIFY that I will comply with all other requirements of a leyal resident of this State.
I FURTHER CERTIFY that 1 have no intention to return to my former domicjle, and I intend to remain in FORT :
1
PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently. Da @Z J. TOwe3/
~
- t
(Name
;
~
~ T.? 8 0~C S S~/~ ~•~T pi~,P~ r F~A, i
(Address)
S~rcrn to and svhscribed before me Ihis ~ th _ day of Au~t?st ~ ~q 7~ .
R~,k> r:011R~.?,S - '
;
C~RCWf`-Cb!l~.i Notary Public
~ .
~
By, ~ D.C. My Commission expires
. . , - - ~
~
. ~
~ . . ~
-
(To M~i ~x~it~d~A yd~p t~ snd ori~insf Rled with Cl~rk Grcuit Couet, and dupliuts with Tax Ass~ssor.)
~ - B~0! 1~74 ~V~.O
~ ~10 13 .
h -
- - - _
. _ . _ .