HomeMy WebLinkAbout2498 Decia: ati~n ~f Domicile and Cr~iz:~,~~:,i;3
TO THE STATE AND COUNTY TAX ASSESSOR. 218149
Sl. lUC1E COUNTY, FIORIDA:
This +s my deciaration of ~om~cile and Citizensh~p in the State of Florida that 1 am f~t~ng this day in accordance a~d
.n conformity with Chapter 222, Section 222.17, Florida Statutes.
! was formerly a legal ~es~de~r of __F,.sh~t~_ _ A~~Ieraey _
(City} (State)
~r.d I resided dr _____36? _ Murray StTe@t_ However I havechanged my domic,ife
(Street and Number)
~o and am an8 have been a bona fide resident of the State of Florida since .__7.~1_ - _ day of
; June_______~, ~9~1_, and I reside ar _~25~ Altura Street. River ParY
~ (Street and Number)
; FORT PIERCE, SAINT lUC1E COi1NTY, FIORIDA
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and tn~s statement is to be taken as my dec{aration of citizensh~p, actual le~ai residence and domicile in the Stare of Fiorida.
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(Insert here any pertinent facss, such as sale of proper;y or business, or retinqu~shnert of e ;vyment
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~ at former domicile, removal of family to new domicile, pu~chase of home, etc.)
~
:`T
f LEO ANO REGQ a Eo S
~ g~, WCIE COU~iy~~'
' POCER ~OIS~!
Establiahing residence ~~EAk ~~R~~IT OOURT ~
- RECORO YER~f ~~0
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_ 3 2 i9 PM'1
~
21.8149
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I FURTHER CERTlFY that 1 will comply with all other requirements of a legal resident of this State.
= I FURT~iER CERTIFY ihat I have no intention to return to 'myi former domic,ile, and i intend to remain in FOR7
?~"tRCE, SAIN7 LUClE COUNTY, FLORIDA, permanentty.
~ , -
. . ~
/ - ~ .;i ~ y . ,,'rLl.~, ~
- - ' . (Name)
_ - . Howard L. Shaw
. . ~ ~
" ~ ' ~~i~~.c.c.r' -
, , ~
- ~'~`r Janet L. She~v
= 5worri~Tp~ar~d subscribed before me this 3rd ~ay of November ~ jq ?1.
ROGER POITRAS _
' RK CIRCUIT COURt Notary Pubtic
/ ~ ~
c-Lt.C.c,-Q~ C~'c..~.c ~ '
3y D.C. My Commissiun exp;res !
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_ (To be exocutod in dupticate and original filed with Clerk Grcuit Court, and duplicate with Tax Assossor.) ;
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