HomeMy WebLinkAbout0495 Deciaration of DomiCile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR. ~,4~52
51. IUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citize~ship in the State of Florida that I am filing this day in accordance and
~n m~formity with Chapte~ 222, Section 222.17, Flo~ida Statutes.
1 was formerly a legal resident of ~E~~~
(City) (State)
and 1 resided at N-~~~---- - . However ! have changed my domiCile
(Sf~eef and Number)
1~/~t.
to and am a~d have been a bona fide resident of the State of Florida since E~G~;f.~L~T_ - day of
~ - - - - - 19~ and I reside at 1~0
~ ~ ~ 4`!C6~'' •
%(~r~eiand Number) 1
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, adual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of propetty or business, or relinquish~nent of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
• ~ G-yt.~ .
ST
IUCt~E COUNTY FLA,
ROCER POITRAE ~
CIERK CtqCU1T COUIIT
RECORO VER.IFtEO
a~ 30 9 2~ aM ~tI
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I FURTHER CERTIFY that 1 will camply with all other requirementa of a legal 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
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
_ 1~ ' ~
(Name) U~~ T K o J i t
~ ,~;~,+a~~ttt.;;;, . .
~ ~ft•+ . /~O! ~ ~
~ ti ~ . ~
ci : ~,~1~5~ ~ (Address)
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Swo~ t~:snd~bscribed before me this ~ day of , 19~
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,~~''~rrr ~CUIT COURT Notary Public
_ .
-
By D.C. My Commission expires
(To b~ ~x~cut~d in dupliut~ and ori~inal At~d with CIKk G?c~eft Couet, and duplfuh with Tax Ass~ssot.)
~ » ~~.96 ~ 495
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