HomeMy WebLinkAbout1058 ~
Declaration ot DomiCile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, ~
Sl. LUCIE COUNTY, FLORIDA:
i
This is my declaration of Domiciie and Citizensh~p in the State of Florida that I am fiting this day in accordance and ~
~n conformity with Chapter 222, Section 222.17, Florida Statutes. #
~
;
I was formerly a legal rws~den! of _ ~~Q~~Qy/!Q - - :
(City) tate)
s
i
and I resided at f~~ e. Q/ ~
_ "l. _ . ~ ~1l _ . ! _ . However I have changed my domiCile ~
(Street and Numbe~)
ro and am and have been a bona fide ~esident of the State of Florida since ~Q V• .4_, __~971- _ day of
- - . 19--7/- , and I reside at _ ~~0 4,~_ o!yi~L ~Q/S C ~J.~ V d _ - - -
(Street and Number)
~:.`~T PIERCE, SAiRlT tUCiE tOUNTY, ~LQRiGA
and this statement is to be taken as my decla~ation of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.) . '
13~/,~.14'qf,~
~~Np,q ~us 9 N ti ~/~t /P /,~cfrs O~C~-
i ~u~?G .~O ~'~a
NRn~c 4.~ ~yJo -C - ~oy~s e.~~ `~i-i ~
~ a 7 y[ /
~l,q ~
.C~ ' a n 4 i~ ~6%.(. 4,~Q d h o~P ~P -%~.s o/~- 7' / 9
'
y ~ ~ ~G .
~ ~
~ Fi~EO ?~o KecoRpQ ;
sT. ~UCIE COUM?Y f~l?• ;
ROCEa POItRAf ;
r~ RECORD VEAIFIEO C~~r
[
Hpy ZZ I 34 PM'~ ~
_
;
~
~
~ 219265
1 FURTHER CERTIFY that I will comply with al) other requirements of a leyal resident of this State.
~ ~
-r
~ 1 FURTHER •CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT ~
z
r; _
~ PiERCE, SAIN'f.,IUG~,CO~lNTY, FIORIDA, permanently. ~ ~~JyJ ~
~
, 1` - .E~l
~ ` _ : y`', _ , -~i•. ~ -fD. r~. i
3 _ _ ~J ~ J (Name) - -
~ ~ ' - ~
5 , ~ ,b . -
~ '
~ ' Jl .Q ~ •.i --~~-'S
~ ' • • r (Address)
C~
~~~~~en~t~llSHl~
~
_ Swom to and subscnbed before me this . day of -_~__~l~~_ , 19 _
~
ROC ER POITRAS +
- -
CLERK CIRCUIT COURT Notary P
Mf? ~ Erpin~ Fi. .16. 1974
By D.C. My Commission expires ~~~r~~
= (To b~ ~xscuMd in dupliut~ and oripinal fiil~d wifh CIKk Grcuit Court, snd dupliut~ with Tax Ass~ssor.)
= 6DRK ~~7~ P.lGi ~V~~
13
:'.i