HomeMy WebLinkAbout1470 Deciaratlon ot Domicile and Citizenship
TO TNE STATE AND COUNIY TAX ASSESSOR, 2~1~53 ~
Sl. IUCIE COUNTY, FIORI~A:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
+n conformiry with Chapter 2?2, Section 2~2.17, Florida Statuies. ~
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1 was forme~ly a legal resident of . __s?~'. _ __S~% - - ~ - -
~ (City) ate) !
and 1 resided at _R ' However I have changed my domiu~~
~ - - -
(Street a Numbe~)
!o and am and have been a bona fide resident of the State of Florida since day of
_ .
19~_, and 1 reside at
- - (Street and Number)
FORT 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 fo~mer domicile, removal of family to new domicile, purchase of home, etc.)
IL~O •Atl~ C0~~p
' T_.LUCIE C0~`EYf#.tM,
2~ . ~ - :ROGE~ Pa1TAA$
CI~RK C:tt;,~11T.CQ~RT [
~ itE~ORC YER!~tEO
; ~AM ~I ~9 :S~.I~!',1~1
~ JQN- k 9'r3
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~ 221453
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~ I FURTHER CHtTIFlf that 1 will comply with al) other requiremenis of a lega) resident of this State.
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~ I FURTHER CERTIFY that I have no intention to return to my forme~ domiG~e, and I intend to remain in FORT
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= PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ ( ame)
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= (Address)
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- Sy~rQrn 1~o and subscribed before me this day of ~ . ~9-Z~~
; _ • '
-'t
' . RCG~'~Q1T~AS _
~tERK C~t~A",COURT Notary Public
s`~ _ _
- 8y ~ i~~ dr D.C. My Commission expires
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Y~ (To bi.~,Mc~ibutsd in duplicat~ snd ori~inal filed with GKic G~cuit Court, and duplicat~ w~th Tax Assessor.)
eoox~~ PACE14~$
No. 13 A
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