HomeMy WebLinkAbout0791 Deciaration ot Qomicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, ^^~wFir I ~
5~. IUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizensh~p in the State of Florida that 1 am filing this day in acco~dance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of ~`~'~~S~r~ _ _ _ _~~~~N~ _ _
(City) (State)
and I resided at _ ~ 3Q ~ l?~~~1~~ f.LJ However I have changed my domi~ile ;
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since ~ S+ - day of
~~?~Ea'~A~X1L~_ , 19_~t~, and 1 reside at ~~3_~_~~~ ~~~`J -
(Sireet and Number)
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. ~
4
(Insert here any pertinent facts, such as sale of properry or business, or relinquishment of employme~t
- at former domicile, removal of family to new domicile, purchase of home, etc.)
FIiEO AyC k:COR~ED
ST. LUCIE CJUMTY fLA.
fi0u:.n 'r~iTRAS ~
• CLfRC Ct~CUI? COURT~
RECORn vf"-~F1~D~..- ?
,lu~ 31 2 i2 PH'72 ~
223p~7
~
~
~
~
~ ~
~ ~
~ ~
~ ~
~ I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State. ~
~ ~
~ I FURTHER CERTIFY that I have ~o intention to return to my former domi~ile, and I intend to remain in FORT
~ FIERCE, SAINT LUGE COUNTY, FLORIDA, permanently_
~
~
~ _~_--~~~~~.Q ~~-C~
~
~ (Name) pQV )02 ~
. /
r,
_ 3 . 3~c. ~ ~t O -S ~u-2 .
_ (Address) ' `
~ `'si~~r+'~ ~.f - ~~Y t~ i
i_; M?~NJ. ~
y'4t .r
~ ~~~a~~~ '
Swom to and subscribed before me this day of ~ 1¢ 's,
? i- ~ _ - ~ _
•
~ J
= ROGER POITRAS • ' r_ • • '
CLERK CIRCUIT COURT Notary Public ~ ~fl~i ~
at ?9~
By _ D.C. My Commission expires Jyne 18, 1974
~lY1d !s ~d Eje~ ~ Grwr~ ~
I
'y~ (To be executed in dupliute a~d originsl fiilsd with G~rk Circuit Court, and dupliut~ with Tsx Assfssor.)
rv;< i 3
iGOX~~ P~iE ~ - j
~r
~ _ v . ,