HomeMy WebLinkAbout2215 I
Deciaration ot Domicile and ~itlzenship ~
TO THE STATE AND COUNTY TAX ASSESSOR. . I i
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Sl. LUCIE COUNTY, FIORlOA: ~
This is my decla~ation of Oomicile and Citi=e~ship in the State of Florida that I am filing this day in accordante and I i '
in conformity with Chapter 222, Section 222.17, Flo~ida Statutes. - t
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I was fo~merly a legal resident of ~~~!¢~t ~E• _~~K ~ • NE~ ~ ~K -
(CIty) (Stat~)
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and i ~esided at ~~~F /~!'E'. . However I have chenged my domitile 4
(Sireet and Number) ~ ~
to and am and have been a bona fide ~esident of the State of florida since ~ day of ~
~'o~PT ~
___~~~L2?~~, 19~, and ! reside at -3-3a~ UN/~ /SE L V~ t~ ~°F ~
(Street and Number) ~
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FORT PIERCE, SAINT LUCIE COUNTIf, FLORIDA ~
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and this statement is to be taken as my declarotion of citizenship, actual legal residence and domicile in the State of Florida. '
(I~sert here any pertinent facts, such as sale of property or business, or relinquishment of employme~t ~
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at former domicile, removal of family to new domicile, purchase of home, etc.) ~
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~IIED AMU RE~OR~t ' ~
~T~ ROCER p41TRAi ~ `
CIERK C+RCUIT COUIIT ~
IIECORD YER~FIEO
' SEr 11 I~ 26 ~!!'T I '
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1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
t FURTNER CERTIFY that I have no intention to return to my former domi~ile, and l intend to remain in fORT
PIERCE, SAINT LUCIE COUN7Y, FLORIDA, permanently. i
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(Name) ~'!'j~{S a A'~ /
`~LL 3 -3 ~ v.?~P~.t r- ~ v~ .
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Swom to a11d subscribed before me this ~ day of , 19~.
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• R06ER ~qqTR?~~_,
, K CIRCU~~ C`OURT ' , Notary Public
8y D.C. My Commission expires ,
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(To b~ ~xecutsd in dupUcats-ar~d origiAal ~il~d with Cl~rk Grwit Court, and duplicat~ with Tax Asstssor.)
sooK195 PACE221~
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