HomeMy WebLinkAbout1698 Gec1 :ration ot Dor~icile and Ci~~::Enship
10 tHE STATE A~.D COUNiY TAX A~SE~SOR,
~ 21'761'7
~i . LUCIE COUNTY, fLORI~A
Th~s ~s my dectarat~on ot Dom~ule and Gt~zensh~p in thc State of Florida that 1 nm fil~ng this day in accordance and
conformity w~th Chapter 222, Section 222.17, Fiorida Statutes. ~
(
F
i ~
1 was formerty a legal resident of _-~~~~~~~~le~~~~~---- - - ' - -
(City} (State) ;
~ ~
and I resided at - _ ! - - . _ - _ However 1 have changed my domic,ile
(Street and Number) ~
~
~o and am and have been a bona fide resident of the State of Florida since _~L~~%~v~ day of
~ ~r ~ n ' 7 ~ y
_ - _ 19-~~, and I reside at _ ~
(Street and Number)
f FORT PIERCE, SAINT LUCtE COUNTY, FLORIDA
; and th~s statement is to be taken as my declaration of citizenship, actual iegaf residence and domicile in the State of Florida.
;
F (Insert he~e a~y pertinent facts, such as sale of property or business, or retinquishment of employment
~ at former domicile, removal of family to new domicile, purchase of home, etc.)
y
'
; ~
y Q/L~nv ( t ST~lUC1E CO ECOApEO 4
~ ~ AOC UNTV fu, ;
= CIERK C RCWT COiJRT ~
RECORD YERIFIEO ~
a
_
= ~tZ~ s9~M•t~ a
- ~~1 ~~~1 ~
n
~ f
;
_ I FJRTHER CcR71FY thaf I wil! compfy with all other requireme~ts of a legal resident of this State. ;
Y~ ~ FU2THER CERTiFY that I nave no intention to retum to my'former domiGle, and I intend to remain in.FORT
~;cKCE, SAIN7 IUCIE COUNTY, FLOt21DA, permanently.
_ j ? i
-i' y n?~ ~ v~~.7~
= (Name)
~1 ' ~ ~
1 ~ ~ ~-C ~
L '
= . (Address)
i
~ ~
Sworn'tb ar~d s~scribed before me this ~ _ day of ~~_`~'~b , 19~_
. : , .
` ~ ROGFR ~OtT~~?S
, . - - -
= CLERK C1RCUfj G4URT Notary Public
'~y ~ D.C. ~11y Commission expires _
cs
(To bo exacut~d in dupliut• and oriqinal filod with Clo~k Circuit Court, and dupiiuto with Yax Assessor.)
- s
_ ~
_ y
~ ROi~11( ~JU N.ICf ~Uc_7?
_