HomeMy WebLinkAbout1706 Declaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
51. IUCIE COUNTY, FIORIDA: v ~~r
This ~s my declaration of Oomicile and Citizensh~p in the State of Florida that I am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of rJ. ~T~~ 5 Q/~__ _ y-~-
~C;ty~ (State)
and I ~esided at _O ~ c~ (,C~O~ d L~ ~ 'y[ _ _~Z . - - - However I have changed my domitile
~
(Streef and Number)
~
to and am and have been a bona fide resident of the State of Florida since ~.tsas F/ ~l s-r - day ot ~
A ? _9 E[ b'~ , 19_~ / , and I reside at ~ ~ _ /Y . •~L l~ aj •~?a~ _
(Street and Number)
fORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my deciaration of citizenship, actual legal residence and domicile in the State of Florida.
(I~sert here any pertinent facts, such as sale of property or business, or relinq~ishment of employment
at former domicile, removat of family to new domicile, purchase of home, etc.) _
~ a.-~ ~~....t ~ z e,-.. $ -v a~Q ~,,.,e /~.p_~ ~ ~ ~Q ~v `-"y ~ ~ ~..~-~-.,Q :
/ a ' ~ i
~ D'~ o~~ t~ Ot ~+~4.~_ Q n1 ~-~-v~ . l.t,' -c ~ 4 a--r~ S..t.s~ L+ ~~.~,t ~u
~
Z.~..~c 7 ~ 'ti•-~.-t~
~ 221632
! Fi~Ea a~c~ !tECORDE~ '
i sT.wc+e cou~tr f~~.
~ }1~Cfa F~ilTRAS
I CLf RK C f~GU~T COURT
; 1tECOP,9 r: ~ =~EO...~..~
; ` ~2 Zs PM'~1 _
a
~ ~
~ ~
~
~
~
~
~
~
X
~ I FURTHER CERTIFY that I will comply with all other requirements of a(egal resident of this State.
~
~ 1 FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remein in FORT
~
~ PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently. ;
~
~.z
~ I["zR" ` ~C~+nn-.+-~ ~
~ _
~ (Name)
~ . - t ~
~ ' = 3 3 F• ~ _ Zr • Z.-. ~~,_iP. -
- ~ ~ (Address)
~ . ~ / ~
~ ~ ~z . . u~7_<, -2_
Swom to and subscribed before me this day of ~ t-__ _ , 19 7. ,
;'"a ~-7^- - r
:3
~ i
ROGER POITRAS
~~RK CIRCUIT COI~RT Notary Public
i~,f ~ / ~ _...~i %
.
~ c~ c -ct 1-E~ '~-'c`'Z ! ~ / .G
By D.C. My Commission expires :
r
~ t
(To be executed i~ duplicsts and original filed with Clerk C+rcuit Court, and duplieat~ with Tax Ass~ssor.)
ao~K198 P~E1704
•~o. 13
_