HomeMy WebLinkAbout1803 ti
Declaration ot Don~lcile and Citizenship
2~1'7Q3
TO THE STATE AND COUNTY TAX ASSESSOR. ~
~l WCIE COUNTY, FLORIDA {
!i
Th~s is my declarat~on of Dom~ule and Citizensh~p in the State of Florida that 1 am filing this day in accordante and ;
n conformity with Chapter 222, Section ~222.17, Flo~ida Statutes. #
~
. ~ ' ~
I was forme?ly a legal res~dent of (Nt ~ l! - - -~-~~~"--~-~--f i
(City) (State) .
i
~
and I resided at _ f. J VIe.~ _ _ However 1 have changed my domicile
(Street and Number)
!o and am and have been a bona fide resident of the State of Florida ince !.ry-~ l1~s day of
,
~.r D~st t a/. L t/~Gr~ '
~
~EIQ. _ , 19~ ~ - , and I reside at _ /~ttT~l~~di ~
(Street an Number) i
S
1
FORT PIERCE, SAINt LUCIE COUNTY, FLORIDA
and this statement is to be take~ as my declaration of citizenship, actual legal residence and domic+le in the State of Florida.
's
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment =
i
at former domicile, removal of family to new domicile, purchase of home, etc.)
197 ~ a,,..,~
W , ~
~ , .
~+~1 -.r,. . Gs'''y` °L ~
~ ~ ~
" ' • Or.l~~•, ~.~M ~i:,,,,v,,,
i ~
' . t 1, n . • ~ ~ D
j~ [.LJ ~~LC.c,a~..n ~cz~v1 ~ ~p . c~..~C Ca..,.^ Ct --w~ ~
i
€
5
~ • 7-~ ~ ~ ~ ~ '11~ - ~ ~Lh1 ~
\ 4 w ~
9
7
' sT
~UC E COUNTY FtA.
~ ~ ROCER POITRAS
~ • CIERK CiRCUIT COU
_ ~~~~0~ RFCORD YEntFiEO
~
~ _ ~AN l II 39 AH'71
~ •
= I FURTHER CERTIfY that 1 wil! comply with all other requirements of a legal resident of this State.
~
~
~
~ I FURTHER CERTIFY that I have no intention to retum to my former domicjle, tnd I intend to remain in FORT
;
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permane~tly.
~ _ ; . ' ~ ' . ~ ~
A ~ , . (Name)
r= . ' • ~ W t~t-lAin Ff . PN RR
y - -
_ ~ t,~~NUm1~~ U~~49GE +}Lj-cNiNSON ~s~.
, MAIt/N(3 (Address) 3EN S EN SEAUf
- ~ ' ` ~ ~ .
Sworn to.and subscribed before me this - day of - , 19~
ROGER POITRAS - -
CLERK CIRCUIT COURT - Notary Public
- i
8y ~.C. My Commission expires
i
1
(To b~ execvted in duplicats and oripi~al filed with Cl~rk Grcuit Ceturt, and dupliut~ with Tax Ass~ssor.)
_ ;
- SOCK198 PAC~~~ ~
- i a
~