HomeMy WebLinkAbout1329 ~ ~ '
Declaratlo~ of Dom~cile and Citisenship j
7
TO THE STATE AND COUNTY TAX ASSESSOR. 22135S
Sl. LUCIE COUNTY, FLORI~A:
This is my declaration of Domicile and Citizenship in the 51ate of Florida that I am filing this day in acco~dance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
- .
! was formerly a legal resident of ' _ _ ~ - -
(City) (State)
,
and I resided at ~,a~y'/i~ , t;.~~»~_r+~_~ f___~ . However I have changed my domic.ile
(Street and Number)
ro and am and have been a bona fide resident of the State of Florida since ;l'/~~~ 1 I~ day of
_ _ , :9.~1, and ! reside at ~Lf~t~~-
-f - - - -
(Street and Number)
fORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this stateme~t is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property ar business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
~~OYItC~c2~ ~
2.~
FIlEO_AMD RECORDED I
~~.~u~+t~uuNTrfu.
ROCER FOITR4S ~1
CIERK Ci~CUIT COURT
RECORC VERIFIEO`~ t
~ 3 ~0 28 a~ ~7z
~
' 2~1355
;
;
;
,
;
~
~
~ -
~
~
}
~
~
~ I FURTHER CERTIFY fhat I will comply with al! other requirements of a legal resident of ihis State.
~
~
I FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT
~
PIERCE, SAINT LUCiE COUNTY, FLORIDA, permanently.
a
~ • ' .
- . . ' . F ; - ~12t~,~i
~ h'iIQ?~~-e--.~-
' • : (Name)
~ A/2 t~ N r'1 a[. (L : e N
: . , ~
. :i? : . -
' ' (Address) -
- " ,
~ . ' ~ ~
Sworn to and subscribed bef re me this day of , 19Z~!'
~ `
~ ROGER POITRAS
~R CLERK CIRCUIT COURT Notary Public
By O.C. My Commission expires
(To be ex~cuted in duplicata and ori~inal filed witl~ G~rlc Grcuit Court, and dupliute with Tax Ass~ssor.)
No 13 A
~ BOCK ~J~ f~lt~i ~e32?