HomeMy WebLinkAbout0618 ~ ~
Declaration ot Domlcile and Citizenship
TO THE STATE AND CUUNTY TAX ASSESSOR,
Si. LUCIE COUNTY, FLORIDA 21f,8`~`~
Th~s ~s my declarahon oi Dem~u~e and C~t~zensh~p in the State of Florida that I am f~l~ng th~s day ~n accordance and y
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~n conformity with Chapter 222, Section 222.17, Florida Statutes ~
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f
Staunton
I was formerly a legal resident of V1Tg1Y11i ;
(City) (State)
and I res:d~ at 1810 North Augusta St• Fiowever I have changed my domiCile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since ~i~ie~ ~3~rh~ day of
Jamiary 71 (Parkx~y aro~a ~states)
, 19 , and I reside at ROUt,@ 0110~ BO]t7 ~
~tree: and Number)
i
FORT PIERCE, SAINT LUCIE COUNTV, FtORIDA ~
and lhis statement is to be taken as my declaration of cit~zenship: actual legal residence and domicile in the State of Florida.
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~ (lnsert here any pertinent facts, such as sale of property or bus+ness, or relinquishment of employment t
~ at former domicile, removal of family to new domicile, purchase of home, etc.)
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~ Living kzth yunt and iincl~ due tu personal reasons.
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~ ffi.ED ~k=' °EGOROEO ;
„ ST. LUC:[ "v~UNTIf FIA. ~ ~
ROGE'~ FOtTRAS C~ ;
~ CIERK CiFGU1T COURT ~ ~
~ aECOP1 YEr~+f?EO
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_ ac~ 8 ~ 41
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" I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTFiER CERTIFY that I have no intention to return to my former damic+le, and t insend to rema~n in FORT
PiERCE, SAitiit LtiCiE ~vUNTY, FLORIDA, permanently.
' ~a _1~~__ ~C. tS_~r` l-_-__-'-__- ' {
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(Name) Ga~y S. Elliott
Bax 1785 USASA Opns Co. ~C/D
Kang Wha Do~ Korea
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Sa~l__F netacp - -
I~a111T1g(Address?
= Sworn to and subscnbed before me th~s U_( day ot r!TY~(/~ i~S~ , 19--~~
F r - )
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Roe~+e ~asw?s _ _ _ _ ~ - _ . ~ . C,~,~~ ~ y~! Z ~
CLFitK CIRCUR COtfRT - ~
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~ 6Y - _ _ - - - - - D.C Mq Commm~ow expites ~ ~ ~
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- (To bt •xecutsd in duplicate and ori~in~l fil~d with Cl~rlc Circuit Court, and dupliut~ with T~x Ass~ssor.)
- dJRK 1c7V PA~,~ Ul~
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