HomeMy WebLinkAbout1574 r.
Declaration of Domicile and Citlsenship
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TO THE STATE AND COUNTY TAX ASSESSOR, ~
221532 ;
Sl. WCIE COUNTY, FlORiOA
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This ~s my detlaration of ~om~c~le and Citizenship in the State of Florida that I am fil~ng this day in accordance and
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~n conformity with Chapter ~22, Sect~on 222.17, Florida Statutes. i
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1 was formerly a legal resident of . _ _ _ _ - - - - ~1- - ~ ~
(City) (St t ) ~
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and I resided at ~3 _ _ _ ~~?!v'~.. _ However I have changed my domic,ile
(Street and Number)
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!o and am a~d have been a bona fide resident of the State of Florida since _ day ot
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~ . , 197~ , and I reside a1 ~ ,i5+,.-~ 7 ~ - `-O'~-~~'~''
~ - (Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, PLORIDA
and this statemer~t is to be taken as my declaration of citizenship, actual legal resiclence and domicile in the State of Florida. ;
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(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment '
at former domicile, removal of family to new domicile, purchase of home, etc.)
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~~'C"~-" u-a--~~-.~~E" - ~ ~ s /~-c~.~~t-~--c.~1
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fIlEO AN~ RfCOR
3T- tUCiE COWtiY ~
ROCER F~iTRAS
RECOR RK~c; ~u~t ~W~
4 v_ IFtEO,~ ~
` ~r 5 10 49 AN'l1
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~ ~21532
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~ I FURTHER CERTIFY that I will comply with all other requirements of a(egal resident of this State.
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~ I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and 1 intend to remain in FORT
~ PiERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ (Name) `
~ ~e ~,ry~ /~1c1`~ I w,4 iN
CY
~ 7 / o / ~ ~ ~ • ~ • J~~~e.._. / ~ • ~
L - -T
(Address)
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Swom to and subscribed before me this day of ~ _ . _ . - , 19 7
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:'~i.'' ~IQQ~1tT6Qt)RT Notary Public
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- gy - z-_- D.C. My Commission expires _
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~ C[o eu~tutid in duplicats and original ~iled with Clerlc Circuit Court, and duplicate with Tax Assessor.) s
yy~ ~3 ;~K1~ ~~572
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