HomeMy WebLinkAbout2538 Declaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FIORIDA ~r~~~~
IGr
This ~s my declarat~on of Dom~cile and Cihzensh~p in the State of Florida that f am filing this day ~n accordance and
n conformity with Chapter 222, Section 222.17, Florida Statutes
T
1 was formerly a tegal resident of _ - - _ - - "~'r-"-
(C;ty) (State)
. ~
and 1 resided at _ 1__~_ _ ~~Q-However I have changed my domic,ile
(Street and N ber)
ro and am and have been a bona fide resident of the State of Florida since _ day of
~ -Y 2$ oS' C~-c--~c , d~° - ~ ~,c.~?-uz ,
_ ~1}'L,(~5..~~4 _ , 19 / and I reside at _ _ _
(Street and Number)
FORT PIERCE, SAINT lUC1E COUNTY, RORlDA '
1
and this statement is to be taken as my declarat~on of citizenship, actual legal residence and domicile in the State of Florida.
~ (Insert here any pertinent facts, such as sale ot property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
. ~
/ ~`A-'~~C. - / ~ . ~
WC E CUUM'f~'RFl1.
- c~ RocF? =a~TR.s ~
~r y~y~~ CLERK C..,CWT ~'vilRi~l~~ R
RECCR~ VE=+ilEO _ ~
_ ~ o .~IM I l~ I~4 AH '7Z
£ - ~ .
E - 2'~'~2~
~ ~ 7
~
~
_
~
;
:
t ~
~
~
~
y
.~k~
i
- t
_ 7
~ ~
i
~ 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 return to my former domicjle, and I intend to remain in FORT
~
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ,
~
~ ~~~C,, a2.~ "e..y..~l
1' }
~r (Name) ~ • s
oSh'/n/s
_ _
_ ;
~
(Address) ~
t
j•y•~; , ~ i
Svwtii~pqnd,svbscribed before me this day of _ , 197
1,:.': '
- ` ~ ~ ROGER POIt'q~ : - _ :
CLERK CIRCt~f'[LCpURT Notary Public
- .
- By , • ~ ~ 5' D.C. My Commission exp~res
- ~
V_y
(To be ~xscvted in duplicats and ori~inal ~ilsd with Clerk Grcuit Court, and duplicsts with Tax Assessor.)
~ = go~K1y8 ~~~2535
, s
; _ -
~
_
,
_
~ , . . _ - . -