HomeMy WebLinkAbout0059 Declarali4~ ot Domi~ile and Citizenship ~
TO THE STATE AND COUNTY ~TAX ASSESSOR. 21034fi
51. WCIE GOUNTY, FLORIDA: '
This is my d~claration of Oomicile ar.d Citizenship in the Stste of Florida that 1 am filing this day in accordance and
~n conformity with Chapter 222, Scction 22?.17, Florida Statutes.
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1 was formerly a lec,~al resident o~ - - ~ - `
(Ciy) ~ (Siaro) ~
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and 1 resided at . ~ _ .~ss~~ - However 1 havc changed my domiti~e ~
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(Street and Numbcr) ~
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ro and am and have been a bona fide resident of the State of Flaids since U dsy of ~
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- - - - LQ,?Q, and I reside at ~ ~
(Street a~d Number)
FORT PIERCE, SAINT WCIE COUNTY, FLORfOA
and this statement i~ to be taken as my declaration of citizenship, actual legal residence and domicile in she State of Horida.
(Insert here any pertinent fatis, such as sale of property or business, or relinquishment of employment
at fo .~ner domicile, removal of family to new domicile, pu~chase of home, etc.)
Establishing Residence
fIL~D t.NC ~iECpp0E0
fT.4UC1E cQUMTr ?LA.
IIOCEF P011R~if ~
CLERK C~~tCUIT CO T ~
RECORO YEF.iF1E0~ ,
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1 FURTHER CERTIFY that 1 will comply with all other requiremenri of a le~al resident of this Stste. ~
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I FURTHER CERTIFY that I have no intention to return to my forme~ domicjle, and I intend to remain in FQRT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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~ (Name) S Y~NQRt, i l~ ~
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620 Texas Court, ort Pierce, Fla. ~
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(Address)
Sworn to and subscribed before me this lOth day of J~e . 19 71 •
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~{$T - Notary Public
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By ~ ~ s. _ .ii°-~;~_ D.C. My Commission expires
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(To . ,ih du~liub and ori~inat ~+I~d with G~rlc Ci~wit Court, snd duplicab witb Tax Ass~ssor.)
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