HomeMy WebLinkAbout0981 Deciaration ot Domicite and Citizen5hip
i0 THE STATE ANp COU~VTY TAX ASSESSOR, ~1~I ~~5 '
51. IUCtE COUNTY, fIORIDA~
,
Th~s ~s my deciarat~on of Dom~uie and Cihzensh~p in the State of Flonaa that I am fil~ng this day in accordance and
;n conformity with Chapter 222, Sect~on 222.17, Florida Statutes.
y-- e
i was forn~eriy a legal res~dent of . _ - _L' - - _ - -T
~ / - (State)
(City)
_ c/fNJ~.v-. `'•L~ - . However 1 have changed my domiule :
and I resided at _ . _S2-._
(Street and Number)
- ~ - -
ro and am and have been a bona fide resident of the State of Florida since day of ~
c 1~ - _ 19 ~ ~ _ , and I reside at B~ T'~ ~ ".c r ~l•e~ r ~ .
- - (Street and Number) !
FORT PtERCE, SAlNT LUGIE COUNTY, fLORIDA ~
and th~s staten,ent is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida. '
(Insert here any pertineni facts, such as sale of property or business, or ~elinquishment of employment
at fo~mer domicile, removal of family to new domicile, purchase of home, etc.) '
~ / ' ~ ~ , ~ ~ o--
G -2--~~+c_fc~E~u_ h~~.~;
- ~ FILEG ~4~ nECOR0E0
ST lU~ IE COUNtr FLA.
~ RO~E~ ~'4~TRAS J,
~ Cl.=KK C'nCU1T COURT ~
RECGR~ Y~~i~lEO
Oct I 3 I I 4o aH't !
' 21'~1~~
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- 1 FUR7HER CERTIFY that t wilt comply w+sn a14 osher reguiremenss of a tegal resident of this Ssate.
1 FURTHER CER7IFY that I have no intention to return tp my 'former domivle, end I intend to remain in FORT
PiERCE, SAINT IUCIE COUNTY, FLORtDA, permanently. ~
_ ~
:
1_ ~ `
- ~ ~f~-:•~
~ ,,..r~
: I
(Name) ~
_ ~ d r c i ti r- r- a ~ c.-. 1
RT f~o ~ l~ 7~ 1
(Address)
Sworn to ar~,su .t~~Nik~O~l~~fore me th~s ____~_1 ~ day of ~c j~ 6 r?- , 19~
.
" ROGER pO1TRAS ; -
' CIERK CLAGWT COURT ~ ~ Notary Public
. ~ .
ay ~ p,C, My Comm~ss~on expires
y (To be executed in duplicato and ori8inal filed with Clerk Circuit Court, +nd dupticate with Tax Ass~ssor.)
- AQOK 1~ PACE ~7~~,
- . . A - _ . . .