HomeMy WebLinkAbout2635 Decla~atlon ot Don~lciie and CttlYenship . %c:12 ~ 2U
T4 THE STATE AND tOUNTY TAX ASSESSOR.
Sl. IUCIE COUNTY, FLORiDA:
Th+s is my deciaration of Oomicile and ~itizenship in ths State of Florida tfiat 1 am fiting this day in ~ao~dance and
~n conformity with Chapte~ 222, Section 222.17, Florida Statutes.
t was forme~ly a legal res+den~ of ---~_'?w, x~r k- _ - V~~~ Ur~
~~;ty~ (Stats)
and I resided at ~a_y 1?~v{r-s~~e- aY~ v~- ?~owe~er ~ have changed my domitile
(Sireet and Number)
to and am and have been a bona fide ~esident of the State of Ftorida since .-~~_~-t day of
19?~_, and I reside at1~L,_ ~'~~~7 ~Q~~ ~'P'~Ve'~
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FORT PIER~E, SAINT LUCIE COUNTY, RORIDA
and this statement is io be ~aken as my declaration of citizenship, actual legal ~esidence and domicile in the State of Horida.
(Insert here any pe~tine~t fads, such as sale of properry or business, or relinquishment of employment
at former domicile, removal of family to new domicite. purcfiase of home, etc.)
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ROCER POITIt~i
CIEAX CiRCWT COi1~T
RECOAO YERIFIEO~
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1 FURTHER CERTIFY thst 1 will comply with all other raquirements of a leyal resident of this State.
f FURTHER CERTIFY that I have no intention to return to my former domid~e, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently_
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(Name) ~avid J . HBWke
~ R . _ , ~t~ ~ /_~c'~/ ~s S ~ ~r~i ~v~ e ~~.c~c s~e_.~ ~
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(Address)
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Sworn to,and subscribed before me this day of - ~ °
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00'~It`'P~iF~tAf' _
R `
~~C41T CO ~ Notary Public ;
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gY D.C. My Gommissio~ expires
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Ro ~t~• ' and ori~inal fil~d witb Cl~rk Grcuit Court, and dvplicat~ with Tax As~sorJ
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~~~r 193 2632 _
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