HomeMy WebLinkAbout2452 ~ 22215~
Declaration ot ~omiCile and Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR, .
51. IUCIE COUNTY, FLORIDA:
This ~s my declaration of Dom~cile and Cit~zenship in the State of Florida that I am filing this day in acco~dance and
~n conformity with Chapter 222, Section 222.17, Florida Stat~tes.
~1 . .
I was formerly a legal resident of K_ ~ C~_ _ -
~C~ty) (State)
and I resided at ~OSG`'`~ a"~~eP °yO~C•y 9 Y
~~f ,S Nowever I have chan ed m domiCi~e
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since ~V ~ `J / 9 7/. _ day of
_ , 19_ , and I reside at 3_ r ~n'? N-~_~ Q--
(Street ana Number)
F9RT PIERCE, SAINT LUCIE COUNTYs FIORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here a~y pertinent facts, s~ch 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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1 FURTHER CERTtFY ihat I will comply with all other requirements of a legal resident of this State.
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~ I fURTHER CERTIFY that I have no intention to return to my former domiGle, and 1 intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. RAYMOND ISENBURG
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(Name)
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~~54yomffb and'su,bu~ibed before me this 14th__ day of _ JanUaY'}i ~q 72 _
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ROG6R . P.OITRAS - -
C K CIRCUIT COURT Notary Public
By ~ ~h'~____ D.C. My Commission expires
Y.
i:.=~ (To be executed in dupliute and original filed with Clerlc Circuit Court, and dupliute with Tax Assessor.)
~~K198 PaCE2449
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