HomeMy WebLinkAbout0533 Declaration ot Domicile and Citizenshlp
2%~2900
TO THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicite and Citizenship in ihe State of Florida that 1 am filing this day in acco~dance and
!
~n conformity with Chapte~ 222, Section 222.17, Florida Statutes. ;
. -
- .
I was formerly a legal resident of +'L~ ~ -
- - - - Cty~ - (State)
.
~yLA'~ e ~'r'~'~~ However 1 have changed my domiCile
and 1 resided at _ . _
(Street and Number)
~o and am and have been a bona fide resident of the State of Florida since [2 _ _ day of
~ 3 p~ ~ /
- . - - /J~I' _
Z-L 'L- 191 / and I reside a~~v i~~~ • a'
(Street and Number)
y
FORT PIERCE, SAINT lUC1E COUNTY, fLORIDA
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
a1 former domicile, removal of family to new domicile, purchase of home, etc.) `
F1LE0 Aht~ RECCROE~
st wc~~ couNSY f~~.
Rai~f= ??tiRAS ~ ~
CLERK C ~ ~tT COURT
4Ff.fi=~ vf~= _D
~ .lai+18 li s4 AH'7[
F
;
~ 2229()0
:
i
s
~
z
;
~
~
~
~
4
~
I FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State. ~
~
~
~ I FURTHER CERTIFY ihat I have no intention to return to my former domic,ile, and I intend to remain in FORT
~ PIERCE, SAINT ~UCIE COUNTY, FLORIDA, permanently. -
~ ~ , s'~'" ,
. ~ ~~~~-~.c~
~ _ -
Y~ . ~H.. ~ (Name)
~ e$S iq. yhArL.a<<<
.-;.~1~
s~ -~i. - Q~
- ~ - ress)
_ , . 'Jr3'~~;'. ~
Swom,to and subscribed before me this _ day of - 19L~.~
.1~ ~
i
ROGER POITRAS f
CIERK CIRCUIT COURT Notary Public '
;
By ~ ~ - D.C. My Commission expires
~
_ r
'-44
ri:y
(To be sxecuted iR dupli=ate and original ~iled with Clerk Grcuit Court, ~nd duplicate with Tax Assessor.)
s °~R~ f,~~ ~ 5~?
- t~o. , ~
-
_ _ - - _ .~y~ .