HomeMy WebLinkAbout0345 ~ ~
~eclaration ot Domicile and Citizenship
i0 THE STATE AND COUNTY TAX ASSE~S:JR. I~~~~`~1 f~i
5~i lUC1E COUNTY, FIORIDA
Th~s ~s riiy deciarahon of Do~n~c~ie and C~t~zensh~p in the State of Fiorida that 1 am f~l~ng ih~s day ~n accordance and
~ conformity w~th Chapter ?22, Sect~on 222.17, Ftorida Statutes
i,~. ~1 , ~ ` , ~
!.vas formeriy a ~egaf resident ot ~ ~ -
(Cityl (State)
,
, ~
t ' ~ ~ r•, , •P
,nd I res:ded at -l ` ~ `1~ ' r: ` tiowever 1 have changed my domi~ile
(Street and Numberl
~y
and am and have been a bona fide resident of the State of Florida since day ot
~ ( f!~.• 19 r , and I reside ar ~ l~c-~. ~ S`~x Y ~ ,"1 P-'- ~-T ~.cic'- ~F
(Street and Number)
KNtfi PIERCE, SAINT WCIE COUNTY, ftORIDA
3^d th~s statement ~s to be taken as my dedaration oi c~t~zenship, actusl legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as saie of property or business, or relinquishment of emp~oyment
at tormer domicile, remova! of family to new domicile, purchase of home, etc.)
r
--~z-~, ~/~~~~~~J~!`lr ~~t~-i~.~.=L
FILED Atip RECOROE.D
ST. ~UC1E COUitT~ fL~.
nn~c~ on~*o.~ ~c
••vv~.. ~ v.~.~wy y~
~ CiERR Ct~tCUtT C~R~ L~/'
; RECOAu YERIf)ffl~r J
~
:
~ O~c ~ 1 3 2~ PM'tl
~
;
~
~
~ ~'~15~
f
~
4~
F
r
b
~
#
~
~
~S`
~
~
~
I FURTHER CERTIFY that I will comply with all other requiremeMs of a legal resident of this State.
~
~
I FURTHER CERTIFY that I have no intention to return to my former dorr~i~ile, and I iniend to remain in FORT
~
~ FIERCE, SAINT LUCIE COUNTY, FIORIDA, permane~tly. ~ ~
~ ~ / f ~t
A~ ~ / ~ ~ ~ fK.Fii1-
~ ~ ~~~-t.~/~/~ L~ a
(Name)
` l2 /f ~r.' /h _ ~.v CL ~ k e rZ
,
, , ,
~
j i7 'd KS.-(~ . , j ~ ~ ~ll
~ ~ ~
- (Address)
; / ~ cs r= = v _ 19~
Swom to and suburibed before me this _ day of _
.
~
ROOER rQITRAS
CLERK'C1RCUIT COURT i' Notary Public
, ~
~ -
2~: FsY --_.,2- ~2~. _ 4^LL~._ D.C. My Commission expires
3i~3
e~:~ - _
(To be executed in duplicate and original filed with Clerk Cirzuit Court, and duplicate with Tax Assessor.)
so~~19~ t~A~t 3~5
_ 3 A