HomeMy WebLinkAbout2991 Deciaration ot Dort?lcite and Citizenship
TO THE STATE AND COUNIY TAX ASSESSOR, ~ _
Si. lUC1E COUNTY, FIORIDA
Th~s ~s my declarat~on o1 Dom~ule and Cit~zensh~p in the Stare of Florida that i am ti~ing this day in actordance and
:n conformity with Chapter 222, Section 222.17, Florida Statutes
';dareto~.~~n Ke~r Jer~ey
1 was formerly a lega) resident of
~C~~,~ (State)
and I resided at 85 Hawkins ~'iSV However I have changed my domic,ile
(Street and Number) ~
~o and am and have been a bona fide resident of the State of Florida since ?`h _ day of
804 So Zake ~rive
Septenber , ~q_71 , and 1 reside at _ - - -
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FIORIDA
and this statement is to be taken as my declaration of citizenship, actual ~egal residence and domicile in the State of Florida.
(tnsert here any pertinent facts, such as sale of property or business, or relinquishment of emptoyment
at former domicile, removal of family to new domicile, purchase of home, etc.)
~atablishing residence 222~~6
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~ I FURTHER CERTIFY that I will comply with all other requireme~ts of a lega) resident of this State.
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I FURTHER CERTIFY that I have no intention to retum to my former domiule, and I intend to remain in FORT
PiERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
n1 ~ - , ~ t-
- - -
` (Name)
Albert ~arka
I' u ~~L~--~--~~L"` "-1=----------- -
~ (7li`]C7~~5) •
_ 1:ary 3.. Parks
Sworn to and subscnbed before me this - day of -~1~d$-T~C-- ~ 19~ •
~ ROGER POITRAS - - ~
_ ~K CIRCUIT COURT Notary Public '
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/~<< c~/`c-~ ~n~~~ _ p,C_ My Comm~ssion expires -
- gY - - -
(To be executed in dup{icate snd original filed with Cferk Citcuit Court, and duplicats with Tsx Assessor.)
aoox 19~3 Pnc~ ~~~8
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