HomeMy WebLinkAbout0509 ~ Deciaration ot Dor~nicile and Ciiizenship
TO THE STATE AND COUNTY TAX ASSESSOR, ~2288~ ~
Sl. IUCIE COUNTY, FLORIDA
This ~s my declaration of Dom~ciie and Cit~zenship in the State of Florida that I am fil~ng this day ~n accordance and
~n conformity w~th Chapter ?22, Section 222.17, Florida Statutes
1 was formerly a ~egal resident of Th0=8i7~11@ _ _ ~`reOr~~B__ _
(City) (State)
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and 1 resided at ROUt@ #2 However I have changed my domiGle
(Street and Number)
ro and am a~d have been a bona fide resident of the State of Ftorida since 3~th day of
I~eceiber , 19?1 , and I reside at 4214 A~re. Qt_~'t. PierceL ~!1. 33450 _
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, 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 any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
RESIDEACE
Fi~EO ~.ra s~caROE~
ST.lUC1E +".~UNTY F~A.
RQG*"~ =:;'TPAS
' C~E~R c ~ut; :.Ou
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Ju~ 28 9 3s AM'7Z ;
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~ 22288~ •
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~ I FURTHER CERTIFY that 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 domi~ile, and I i end to emain n
~ , °/Z~ :
PIERCE, SAINT LUClE COUNTY, FLORIDA, permanently. ~ t
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~ WIZI,IA1[ LZOYD wII?KES _
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;s, , , (Name)
, .
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_ , - • ~ , -
~'':v~-` 4214 A~e. ~'t. Pierce ~'1 `
~~f ' : Q t.-- ----l----- -
~ z ~ = :~i ~-'~~i'l. : ~ (Address) -
x ; ~ . 33450
~ ~1!~` J i~G Y.fY . ~ • : .
28t1~ Janua
•.~'•.;~`~'Tf:tO Pi~lrs~scribed before me this day of r1--- 19_~
~.,~~:.~.~~y
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~RdGkR~,POITRAS
C CUIT COURT Notary Public
= By _ ~ D.C. My Commission expires _
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(To be oxecuted in duplicate and original filed with Cl~ric Grcuit Court, and duplicste with Tax Assessor.) ~
oK~g9 F~~E 508 ~
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