HomeMy WebLinkAbout2222 D~:~lar~:fiian ot nomic~te Gr~J t'.i:i~~.RJ~I~I;~
T~ iHE STATE AND COUtiTY TAX ASaE~OR,
Sl. WCIE COUNTY, F~oR~~A 21'7956 ~
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ih~s ~s my dec~arar,on of ~om~c~~e and C,t~zensh~p ~n the State of Ftor~da tha: I arn ril~ng th~s day in ac:~rdance and ~
~n conform~ty w~th Chapter 2~2, Section ~22.17, Ffor+da Statutes.
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I was formerly a iegal resident of - ~
(City) (Stote)
and ~ resided at _ . However i have changed my domicjie
1~~~u (Street and Number}
ro and am and have been a bona fide resident~of the State of Florida s~nce day of
' ^
i __~~!1_ ~ l9_1~.., and 1. ~eside at ~?`?y~_ ~ ~ ~
, . - - - _ _ _f-__
(Street and Num er)
~ORT PIERCE, SA~NT LUCIE COUNTY, FLORIDA
ar,d this stateme~t is to be taken as my deciaration of citizenship, actua! legat res~uente ar.d domic~le in the State of Fior~da.
{Insert he~e any periinent facts, such as saie of property or bu$iness, or re{inguishmznt of employment
; at former domicile, removal of fam~ly to new domicile, purchase of home, etc.)
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~ ~.e~t~ G~G~~,~r~ ~
- -t~~0~~~`~-~. -/1l
/ ~ f11E0 ~yC REC~~ Fl~. y
= ~~~4~-~~~~ - ~ ST.~UC1E G011N
RBCER PO~tRJ?S ~c~~
REC~Rd VERRFIEO COY~
NOV { IZ 44 e~ ~ ~ ~
21'7956
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I FURTrER CERTIFY tha. I will comply with ail other requirem~n;s of a legal res:dent o~ this State. z
! Fu~7r-iER CcRTI"rY shat I have no intent~on to retum to 'my former domiGfe, and {~ntend to remain in FORT
" Pi.G,RCE, SAlN7 IUCIE COUNTY, FLOR;DA, permanentiy.
A ~~J
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ddress~
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- S~,q~xn to artd ~iscribed berore me this - ~ / " day of ____L-.~~'~i-~~ , 19~. ~
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_ , . ~ ~ ~
- ~ ROGER P017~?5 '
_ !E ClRCUjt CQ~JRT Nosa;y Puo;~c
_ - , . . ~ ` i
~y ~.C. My Commissson exp~res
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(To be oxecuted in duplicate and original filod with Ctc:k Ci!~~~:: Co:.+rt, and duplicato with Tax Asscssor.)
_ ~ p b00K 1~7V PACE~~~.O
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