HomeMy WebLinkAbout2216 Oeclaration ot Dorr~i~lle and Citisenship '~i 1~5.~ g
TO THE STATE AND COUNTY
TAk ASSESSOR,
Sl. lUC1E COUNTY, FIORIDA: _
This ~s my declaretion of Domic~le and Citizenship in the Sta~e of Florida that I am filing lhis day in accordsnce and
~n confor~rity .vith Chapter ~2~, Sect~on ??Z.17, Ftorida Statutes.
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I was formerly a legal rasident of l~[Q~l~~-- ----~L~_• - i
(Ciy) (State) j
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and f residsd at /S d 7 ~T~1_V /~'-(-l..~--- ' However 1 havechanged mydomitite ;
(Street and Number) _
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~o and am and have been a bona fide ~esident of the State of Florida since ~ V day of i
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. _ . - • 19~~ , and 1 reside at «~d t~' h r' f - - - - -
- (Street and Number)
FORT PIER~E, SAINT LUCIE COUNTY, fLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal reside~ce and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment -
at forme~ domiciler removal of family to new domicile, purchase of home, etc.)
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UCIE COUMTY FIA.
CLERK
C RCUIT C
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~ECORO YERIF1Ep
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1 FURTHER CERTIFY that I will compfy with all other requirements of a leqel resideat of this State.
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t FURTHER CERTIFY that I have no intention to return to my forme? domicjle, and 1 intend to remain in FORT :
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PtERCE, SA((~i,~UC1E COUNTY, FLORIDA, permanently. ~/jl~t,L . ~~r..~,..~~
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, • Yariaa Fddins
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Swom to and subscribed before me this ~ay of ~ ` , 19 T
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ROGER /OITRAS ~ #
C}ERK CIRCU~- COURT Notery Public }
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By~=---- - , D.C. My Commission expires
(To b~ ~x~cuNd in d~pllcN~ and oripinal fil~d with Cl~vk G~cuit Cour1, aed dupliuh wiN~ Tax As~swr.)
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