HomeMy WebLinkAbout1606 Declaration ot Domicile and Citizenship
10 THE STATE AND COUNTY TAX ASSESSOR, Sc~
.rlN,l V
51. IUCIE COUNTY, FIORIDA
This ~s my declaration of Dom~cile and Cit~zensh~p in the State of Florida that I am filing this dey in accordance and
conformity with Chapter ?22, Section 222.17, Florida Statutes.
~
~~~J~, ~ '
I was formerly a legal resident of __tiC1/'c.~ ~jr,G~CfC~,'L~([ --.-C.d
l~--- -
(City) (State)
1 resided at - ~ - However I have changed my domiule
(Street and'Number)
ro and am and have been a~ona fide resident of the State of Florida since ~~j' _ day of
, 19_~~, and 1 reside at _ ~~L~_ _ ~ ~
(Street and Number) ~
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be t~ken 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 or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
. ,
/~-G~-G'~C-~
`/r ~L~
~
~
, y- r
1 ~V
! !"~,c~~,v FILEO AN.? RECORDED S
G~ L ST LUCIE i,"vJNTT FLA.
; ROCE? ~^:~RAS ~L~
' CLE~K i :aCU~T COURT ` ~
i RECO^' ~'='F~ED
~
~ ~ ~j ~2 45°n'~i
F
E - ~561
~
~
~
~
~
~
~
~
~ I FURTHER CERTIFY that 1 will mmply witt~ all other requirements of a legal resident of this State.
~
~
~ I FURTHER CERTIFY that I have no intention to return to my former domiUle, and I intend to remain in FORT
s PIERCE, 'SAINT LUCIE COUNTY, FLORIDA, permanently. ~
~:~<<;ut~:.... -
~ +JZ ?`~r.CO ~J • -
, ~ l~f~`'; 1~/~ '
~ • . ; . r . - -
~ : ~~.;x , c`. : • ,
~:i ` ~ (Name)
_ ? ~ t - L' fi ~ ' S ~ ° S ~ e S C /J
J,~ ` , `
~ ,
~r a';a` - ; c;~ =
: ~ . ~ ~ - ~ ~ _L~~~~_1l~-
Y* .\.t-ti. ~;yE1
~ ~ • (Address)
. . ir„ ••s • 'G*~ , ~ /
~
Sworn to and subscribed before me this day of , 19~~
.:a
i
ROGER POITRAS - _ -
- CLERK CIRCUIT COURT Notary Public
~ 1
~ y.,
By __-_!___!!"~L_ D.C. My Commission expires
r.' •
i:~;
~ (To be executed in duplicafe and originsl tiled with G~rk Grcvit Court, and dupliute with Tax Assessor.)
- $~1~ ~~~4
_ ~:o ~ 3
~ : :