HomeMy WebLinkAbout2752 Oeclaration ot Oomicil• a~d Citizenship t
TO THE STATE AND ~AUNTY TAX ASSESSOR. „ 2122US
Sl. lUC1E COUNTY, FLORI~A: ~
This is my dettaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in att~dar~oe and
~n co~formity with Chapter 2~?, Settion 222.17, Florida Statutes.
?
I was fo~me~ly a tegal reside~t of ._1_~e~ ~ ~~K' ~rs y . -
(City) (State)
and 1 resided at ~~6--%Ne~~ s~~~ /0I~ /eOstl.~. - However I have chanqsd my domitjle
(Street and Number)
~
to and am and have been a bona fide resident of the State of Florida since day of
~-Q/`C.~ - 19?~ , and I ~eside at Jr0/ T~f liwt h ~D//t ~ ~l/ve
(Strcet and Number) .
PORT PIERCE, SAINT LUCIE COUNTY, FLORIDA ~
and this statement is to be taken as my detlaration of citi=enship, actual legai residence and domicile in ihe State of Florida.
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employmer~t
at former domicile, removal of family to new danicile, pu?chase of home, etc.) .
~
_ ~.~~K c~
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~ 2122U8
t lE0 ANO lIECOR t
AOCEA ~Oit~ 1 _
CIERK C1fiCUlT COIIRT
RECORD VERIFIEO.~.~~
,I~ 13 10 t~ ~M'1 ~ .
-
~ ~
I FURTHER CERTIFY that I will comply with el) other requirsmenri of a leysl resident of this State.
I FURTHER CERTIFY that i have no intention to return to my former domicjle, and I intcnd to remain in FORT
PIERCE, SAINT LUCIE COUNTY, fLORIDA, permanently_
, ~
: . • ~N
- . . - " . ' _ ~ T.J l[cPer~l d Jr
. _ .
_ - (Address)
_ . . '<<~~ . ~
; ;Y;'' ~
' §wbT1~.iQ ~+y~~ubscribed before me this ~ day of , 19~.
. ~ : ~
- !
ROGER fO1TRA5
CIRCUIT COURT Notary Public
T
By Q'~''~~ D.C. My ~ommission expires
1To b~ ~x~cut~d in dupliuts-s~d o?i~inal Rl~d will~ CIKIc Grcuit Co~if, and duplic~t~ with Tax Att~s~er.)
a~ 193 z74g '
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