HomeMy WebLinkAbout2839 Decla~ation ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
S~. !!!~!E CL".l~+llY, sIQR!~JA: -"~~49
This is my declarat~on of Oomicile and Citi=enship in the State of Florida that 1 am filing this d++y in accordante and
~n conformity with Chapter 222, Sectio~ 222.17, Floride Statutes.
1 was formerly a legal resident of _ Q- D~l ~
(C ) (State) .
. / ~ ~ ~
and 1 resi~r:! at ~l L~t h.~ 4~ f/E .-L~_ Haw~ver f hava zlra~ed my dani~ta
(Street and Numbe~)
~
ro and em and have been a bona fide resident of the State of Florida since f•5--1' day of
~v ~11-- . 19~~, a~d 1 reside at ~ / ~ S• F ~ ~ o I- ~h
treet and Number)
FOlt? PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
S o ~ ~1 /S o ~e / ~Q.. TO 7 d h / ~d
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f . /~p ,y, ~ S 1~--~.~. d ( ~ ~ y o ti
n ~ ~v r-
E - F~~EO AMO RECORgEo
~ ST.IUC?E COUNjY lA. ~ ~
i • qOCER ?O?TR~t
~ CLERI~ C~RCUIT COUItT
? RECORD VERtFtEO
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€ v OEC I~I 9 y9 I~1'T i ~
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~ 1 RIRTHER CERTIFY that 1 will oomply with all other rsquirements of a leyal resident of this State.
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~ I FURTHER CERTIFY that 1 have no inienfion to return to my former domicjle, and { intend to remain in FOR7 ~
~ ~
PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently. ~
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: Swom to and subscribed before me this day of ~~1~ , 19 .
- ,-r, ~
. ; ~ ROGER •~~f't'RAS
C1~11jT:COURT Notary Public
.
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J;,y gY D.C. My Commission expires
a_'~~- . .
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(To b~ ~x~urt~d in dupliut~ and oriqinal fil~d Gl~ric Gnuit Gourt, and duplicat~ with Tax Ass~ssor.)
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