HomeMy WebLinkAbout0226 Declaration ot Dor~icile and Citizenshlp
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FlORIOA:
This is my decla~ation of Domicile and Citizenship in the State of Florida tha! ! am filing thEs day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of . ~ ~~k~u wl`!___ S _ _~~E ~-~!~G~ _ .
' (City) (State)
and I resided at ,,2 °p _/'t~~ ~~X~~~~ _ However 1 have changed my domiGi~e
(Street and Numbet?
fo and am and have been a bona fide resident of the State o4 Florida since ~~G ~ _ day of
_ _ _ , 19_7 ~ , and 1 reside at _ / /J.~-~I~ G~oac ~ T,~q. ~~~t ~'G~ %Q~ - - - - - -
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actuat legal residence and domicile in the State of Florida. .
(Insert here any pe:tinent facts, su~h as sale of pruperty or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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~ I FURTHER CERTIFY that I wil) comply with all other requirements of a leyal resident of this State.
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~ I FURTHER CERTIFY that 1 have no intention to return to my former domi~ile, and I intend to remain in FORT t
~ P?ERCE, SAINT lUC1E COUNTY, FIORI~A, permanenNy.
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c: • - ^ (Name)
- ~ Doneld I,. Ker.nr
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- . . , _~_PT~-• ~R 9 ~ ~ 5 1 - - - -
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: Sviram tio and subxribed before me this _ ~ _ day of _ , 19
V~~ ROGER rO1TRAS
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_ ~LERK CIRCUR COURT Notary Public
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9y''~._ D.C. My Commission expires
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(To b~ ~x~cut~d in d~pliut~ and ori~inal fi{~d with derk Grcuit Court, and duplicat~ with Tax AssKSOr.) E
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