HomeMy WebLinkAbout1504 j
t7~ciaration oi DomiciEe and ~:::zens~ip
TO THE STATE AND CUU~
JTY TAX A~SESS~R, . 1~`~89 ~
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Sl. : ;CIE COUNTY, F~ORIDA: ~
Th~s ~s my d~ciarat~on of Dom~ciie and Citizensh~p in the Staie of Florida that { am fil~ng th~s day in accordance and
conformity with Chapter 222, Sect~on 222.17, Florida Statutes.
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i was formerly a legal resident of _.___1_~ -j l
(City) (State)
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~nd I resided at ~ _ _ _/.--~'L-~~y?~--±~-'~"'_____ , . _ However I have changed my dom+cjle ~
(Street and Number) ~
,
~o and am and have been a bona fide res~dent of the State of Florida sinte _ ~_tday of
~~?--~Lk.: ~a:~L~z./ f~,~
19._.! and I reside at 1~~~C
` (Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY~ FLORIDA
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and this statement ~s to taken as my decla~ation of citizenship, actual tegal resid~..ce and domicile in the State of Florida.
; (Insert here any pertinent 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.)
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I~ L_~.c E-~' ~-c_--, ~c.. , = %c~'c CLERK CIRCWtQpMt ( .
~,t 2 t- RECORO YEi11~~_ I~1
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- I FURTHER CER7IFY that I will comply with al{ other requirements of a legai ~es~dent of this State.
I THE~ ~t2TiFY that I have no intent~on to retum to my 'Former domicjle, and I intend to remain in FORT
+'~ERCE, _~T.lu~ CO;fNTY, FLORIDA, permanently.
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- ti: ; ~ GC~ ~ '1,% - ~.~-f G~ ~il ~ Li -
(Name) ~
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Swom to and subscnbed be`ore me this day of `_~~f , 19
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ROGER POtTRAS
_ CIERK CIRCUIT COURT Notary Publi~
- 3Y . ~ " -.~j~~? { r ~<<~ ~ ~ - D.C. My Commission expires
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~t (To be oxecuted in duplicats and original filed with Gork Circuit Couri, and duplicat~ with Tsx Asseuor.)
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