HomeMy WebLinkAbout2106 )
Declaration ot Domicile and Citizenship
TO TiiE STATE AND COUNTY TAX ASSESSOR, ^
a~9s4
51. LUCIE COUNTY, FIORIDA:
This ~s my declaration of Domiule and Cit~zensh~p in the Sta~e of Florida that I am filing this day aaordance and
conformity w:th Chapter 222, Section 222.17, Florida Statutes.
~
I was forme~ly a legal resident of ~
• ~~;ty~ (State)
~ r ~ I~--tx However I have chan ed m domicule
anci . :esided at _ 9 Y
(Street and Number)
~ o..~`
ro and am and have been a bona fide resident of the State of Florida since Y day of
- - 19_--, and 1 reside at ~a ~S ly~Gsr~~ ~+a--~~~-
(St eet n umber),
` Z ~ C~.tat_.e / .
EORT PIERCE, SAIN? LUCIE COUNTY, FLORIDA
and th~s statement is to be taken as my declaration of citizenship, actual legal residence and domicile in fhe State of Florida.
(Insert here any pertinent facis, such as sate of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
,
G
F~~OA~t?R
E 5~~ «~~c ~ou~~~r~~~~-
A~OEe3 FO~T~~~ ~,~1
; sf~a~~@ YER~~~p
QOY~L
~ ~
` ~ e ~ ~
~
s
~
Y ~19~5
~ 4
~
~
~
~ I FURTHER CERTIFY that 1 will oomply with all other requirements of a leyal resident of this State.
~ I FURTHER CERTIFY that I have no intention to return to my former domi4le, and I intend to remain in FORT
; PIERCE, SAINT~LUCIE COUNTY, FLORIDA, permanently. HOWARD E. C~iASE
~ : ~,~s~,~~rrrsrr t
~
j ~ t~ 't i C
. v ~ v ~ -~+-'Q
.:n~ . . G :
.~1 V ;•'s~..~~ ~ - • .r (Name)
• • ~ t. j ~G
: =
- . ~ -
- - V~~ a•• ~
` v • ~ • ~`i~
_ - : ~ : _ ~ ~',~J
_ -a: ; _
. .
` - ti.• Y y ? (Address)
- ` ~'y , .
~~,f',..• ~l, ~ ~9 I ~
Sworn'~o ~and subscribed before me this 6th day of ~ZET..~g_F •
ROGER POITRAS
- K CIRCUIT COURT Notary Pubtic
gy a-~ D.C. My Commission expires
~
~
(7o be exewted in duplicate and original filed with Gerk Grcu+t Court, and duplicat~ with Tax Asseswr.) !
BOCK197 PACE~IQ~ '
. _ _