HomeMy WebLinkAbout2110 Declaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, 215`798
Sl. WCIE COUNTY, FlOR1~A:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordante and
,
~n conformity with Chapter 222, Section 222.17, Flo~ida Statutes.
~
I was formeriy a legal reside~t of - -
~~;ty? ~ ~ (Stata)
,
and I ~esided at However 1 have changed my domic~le
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since day of
- ~ ~ 19-~~-. and I reside at ~ 4 3 h ~ -39'~ "
(Street and Number)
FOR? PIERCE, SAIN? IUCIE COUNTY, FLORIDA -
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
. _ _ . _ . _ _
(Insert here any perti~ent facts, such as sale of property or business, or relinquishment of employment $
at former domicile, removal of family to new domicile, purchase of home, etc.)
' J ..L~tC~ ~G~-/~~ .
~ %C~1'~ • • :
~i~l~~J ~ ~ .
~
:
' ~ F^w"~ ~ -.4
~`'~~,2~
i1Lf0 AMQ RECOROE~
t ~ • fT. WCIF COIINTY it~
AOCER POITR~t
CIERK CIRCUIT COIIRT .
~~r~ RECORD 1IER~FIEO
, ' ~ ~ir 20 10 4s ~M'l!
, .
~
:
; ~
F
~15'798 ~
1 FURTHER CERTIFY that I will comply with all other requirements of a lege) resident of this Stato.
I FURTHER CERTIFY thnt I have no intontion to roturn to my formar domici~c?, end I intond to romein in FORT
NtERCE, SAINT LU~E COUNTY, FLORIDA, purmanontly.
: :
d~~~'
~ • , ~
, ~f
;``,~T (Name)
.:~vt:
• ~f -
. , ~ ~ .
az _
_
. : ~ (Address) _
• ± ~ R /
~ ~ ~ • . ~ .
SWOrn to and subscribed before me this '2~ day y``'~~'~ . 19~•
ROGER POITRAS
K CIRCUIT COURT Notary Public
gy D.C. My ~ommission expires
(To be •xecuted in duplicats snd origiAal filed with Clerk Circuit Court, and duplicate with Tax Asstssor.)
gooK195 PAGE2l08
t:-1 i ~ A - _i~
-.5:~~ ~ 59c'-~~`.`~~•"ra:y . . ~,~y~~s"t"+a~*"~..i~'' ,