HomeMy WebLinkAbout2422 .
Declaration ot Domicile and Citi:enship 2'~%'~.~~
TO THE STATE AND COUNTY TAX ASSESSOR, , ~
S~ . WCIE COUNTY, FIORIDA:
Th~s is my declaration of Oom~ule and Citizensh~p in the State of Florida that I am fil~ng this day ~n accordance and
n conformity w~th Chapter 222, Section 222.17, Florida Statutes_
- _ v,e - :
I was formerly a lega~ resident of ~Su! ~T?1_ _ ~ - - - - 'C+ - -
i
~C;ry~ (State)
D
/ /I Q S
and 1 resided at ~~cs/ f!'~'C'~T_ However I have changed my domicjle ~
(Street and Number) ~
t
~o and am and have been a bona fide resident of the State of Florida since ~~'TFMi3~/~ day of ~
~
3
!
~ J-/ ~ (y ~ O ~.I' ~J ~~L ~9 .t S. O ~Z T ~ o~ _~!C . ~''L~ r ~
~ , 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. .
i
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment ~
at former domicile, removal of family to new domicite, purchase of home, etc.)
FILEC A!+:' ~ECOR~~D
St.I~UGic_;•OUMT`I FlA•
r ?,.:lR~s
CI:i+K C~ CCUftT
q f~r,~,, ':r• =~E~
~ ii sa AM' (Z
;
; ~~~'1-34 ;
~ ,
€ ~ ~
~ ~
~ ,
z ~
a
S
C
~
v
~
x
~
~ I FURTHER CERTIFY that 1 will comply with all other requirements of a lega) resident of this State.
~
~ I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
~
~ PI~RCE, SAINT LUGE COUNTY, FLORIDA, permanently. j
~
~ ~ / B72~f 2GG /CG-~% _ ~
~ (Name) .n e k k E IQ
.
~ ~f-~~ - ;
_
~ ddress)
Sworn to and subsuibed before me this ~y day of -_~t~__ 19 '-L
:.=f ~
~=g ROGER POITRAS - - -
= CLERK CIRCUIT COURT Notary Public
By _ ~~'s~~l _ D.C. ~ My Commission expires ~
_ ~
ti`~
(To be executed in dupliute and oriyinsl filed with Clerk Circuit Court, snd duplicaN with Tsx Assessor.)
~ ~~K1~ ~~4i9
',0 13
. :
, -
. . . _ . . _ . _ . -