HomeMy WebLinkAbout2037 N'
Declaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, ~~~8~2
;il IUCIE tOUNTY, fLORIDA
lh~s ~s my declaration of Don,~ute and Cihzensh~p in the State of Flor~da that i am fil,ng th~s day ~n accordance and
:n conformity w~th Chapter ?2?, Sect~on 222.17: Florida Statutes
-~J i!: ~y~ ' ~
/(.~~~;f ~i.~ ` ! /~-C!G` ~ ~ ? ~G'~-~b
1 was formerly a legal resident of _
~ (City} ~ (State)
~ % J~. ~
and I resided at ~ ~*'L(~' /I,Y~L9~~ However 1 have changed my domic,ile
{Street and Number)
fo and am and have been a b~na fide resident of the State of Florida since ~~1"~G~ ~
j T~ day of
~ , ! ~ 1
/ ` ~f'cs .
~-~CC//" , 19 and I reside at ~ ~ 1~
~ (Street and Numbe~)
FORT PIERCE, SAINT WCIE COUNTY, FLORIDA t~ ~ r~u "
and th~s statement ~s to be taker~ as my declarat~on of cit~Zenship, actual fega! residence and domicile in the State of Florida.
(Insert here any pert~nent facts, such as sa!e of rs~perty or business, or relinquishment of employment
at former domicile, removal of fam~ly to ne~v domicife, purchase of home, etc.)
' --!L- ~ ' ' ~ ,
~ _ „ - c ~ l{.1_ fl~ ~ c ~ ~ c e~.~ . .
_ ~1 `7~
' ~ fILEO AND RE~,~~
'i . s .1 l ~ . i ~ , c j.? l : ~ . :T. lllCtE COUM
i
? CtER4K C RCWTMO~T m ~
IIEGORD VERIFIEO ~
a
= pci 28 9 ~ ~ ~
S
~ ~ 21~'8 -s 2
Y
3
N
S~
i
k
- I FURTNER CERTIFY that I will comply with al) other requirements of a legat resident of this State.
i
I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
-ti
- PIERCE, SAINT LUC~E COUNTY, F~ORIDA, permanently.
~
, ~ ~ /i~/~~--L-~- _ - - -
,~j (Name)
~ ~ 7
~ ' ~tt'-~
~ _ _ ` -~~-~'~'t - - - - - -
(Address)
~ ^ t ,F-.
1 /
Swocri'}p'M~c~;wbsccibed before me this . - day of _ C lc~ c- _ _ _ 19 JL.
• .
, y l .
_ . r~
. . . , .
~ . ~
' ieex~ ror~kp~`' .
_ : • . - _ - - - - -
= CL~RK CiRCU1T:~I,IRT ~ Notary Public
~ -
SY / ~ .~.-=~`--~-=1-~' D.C. My Comm~ssion expires
~ . , .
~ .y;~~e.L!~3: .
(To be~~xecuted in duplicale and origins) filed with Clerlc Circuit Cou?t, and duplicate with Tax AssessorJ
- ~'~~R.1~~6 r.~~f 2U34
_ „
~