HomeMy WebLinkAbout1246 Declaratio~ ot Domicile a~d Citisenship 223338
TO THE STATE AND COUNTY TAX ASSESSOR, ~
51. IUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizensh~p in the State of Florida that I am filing this day in accorda~ce and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
~ / R/dC~/~~ K ~CC. ~r/ y,C~~ -
I was former~y a legal resident of _ _
(City) (State)
i
~ ~ However 1 have chan ed m domiCile i
and I resided at ~ ~ ~ C~_ ~ve- 9 Y ~
(Street and Number) ~
ro and am and have been a bona fide resident of the State of Florida since h ~-7 day of ~
~
, 19__ , and I reside at _ ~ __~r~ ~ 3-' ~ y~ 3
_ _ . _ - - _ ~
(Street and Number)
FORT PIERCE, SAINT LUCIE 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 propery or business, or relinquishment of employment
at former domicite, removal of family to new domicile, purchase of home, etc.)
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223338 ~
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RILEO R!~^ ~ECORDfQ~
~L~ LUCic. :.OUli-~Y~F.L'R..
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~ I FURTHER CERTIFY that I will comply with all othe~ requirements of a legal res~dent of this State. i
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~ 1 fURTHER CERTIFY that 1 have no intention to return to my former domiGle, and I intend to remain in FORT ~
~ • i
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. €
~ _ ~ '
~ _ . . . , (Na e) - ~
. ~ Cynthia ~ I,eggiere ~
~ ~ . , l~'`f /l-ti~- ' ~
. ~ ~ _ _ ~
~ • ~ (Address) .
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-Sw3rn to and subscribed before me this ~ - day of ~~_ti~'' , 19~_2' ~
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ROGER POITRAS -
rti K CIRCUIT COURT Notary Public
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By D.C. My Commission expires
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~ (To be ex~cut~d in duplicate and ori~inal ~iled with GKk Circuit Court, and dupliut~ with Tax Assessor.)
- BORK199 PACE1~45 ~
No. 13 q
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