HomeMy WebLinkAbout1326 4-
Declaration ot ~omicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR. ~
;c213 ;
Sl. LUCIE COUNTY, FIORIDA. ~
This is my declaration of Domiciie and Citizensh~p in the State of Florida that 1 am filirtq this day in acco~dance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
.0 /I ' ? ~ /1
" ~ ~ ~ ~ :
, ~ _ ~ ~
I was formerly a legat resident 9f "fr ~ ' ~ ~ ~
- -
(C;y) tate)
:
~ ~
and I resided at y~ ~-~r Q~~'~'~~--~~"~.=---.-- . Howeve~ 1 have changed my domicile
~ L
(Street and Number)
ro and am and have been a bona fide resident of the State of Florida since _ day of
j
~ ?
, ~ .
- ~ 19~~, and I teside at o ' ~ /
(Street and Numbe~
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual tegal 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 domiul purchase of home, etc.)
J , ~
-~~ti~ Q~` i~l~; ~.L~ ~T-G . , ,
~ % , , . , ^ ,
•n- ~ ~3 ° ~ ~'~d~ .,~~-ol,,~'ic,v
~ ~ /~J ~
,o-c.~2 ~2~ ~ , t~ y.;,v-~ Y,~~-~'` ~ / /
~ , - - - ~ ~ -
~ ~
, , ~ S~
, ~ .
~a ~ ~ ~
~ - - ~o~--
f ~ ~ q
~ . ~
, i /
' :,c~rr~ lS ~e- ~ ,~,n
; / `'o q
\ .
a
}
~
~
~
~
S
~ ~
'f
~ I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State. f
~
~ I FURTHER CERTIFY that I have no intention to return to my former domic,ile, and I intend to remain in FORT
~ PIERCE, SAINT IUGE COUNTY, FLORIDA, permanently.
~ FILED RNO ~cECORDE0
~ ST LUCIE COUMTY fLA. ?11,) i~
a ROCER P~ITp~S
~ RECORC YERIFiEO COURT ~ (Nam~
~E ~,'nl
Y -'~M 3 ~0 O? ~ R°b eRt ~ _
`3 ' , -
.f~~/• A
- . ' r~~~ ` . SS ~ ~
- . ~ . ~ = 221352 , _ , •
. ~L ~
~ i Swora;to subscribed before me this ~ day of , 19~~!~
• ? ' : j ~r
_ ~ • . ~ ' - /
~ , j~r
- ~ ~K CIRLUIT COURT Notary Public
By ~ D.C. My Commission expires
_
_ (To b~ ~xecu»d in dupliute and ori~inal ~iled with Cltrlc Grcuit Couef, and duplicab with Tax Ass~ssor.)
i" ,3 , aooK19~ ~ac~1324
~