HomeMy WebLinkAbout2027 G~ ~ j
DeClaratio~ ot Domicile and Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR. 2z3912
51. IUCIE COUNTY, FIORIDA:
This ~s my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
t was formerly a legal resident of ~~~~v'r - - - - - 0~~!-- -
~C;ty~ (State)
,
and 1 resided at ~~~G /~''~!G_ However 1 havechanged my domiule ?
(Street and Number) ~
~
,
ro and am and have been a bona fide ~esident of the State of Florida sinte _ /Y`t ~r ~ 1_Q~~ day of i
t
- _ , 19-_ , and 1 reside at ~3% S~ ~r~iii_t~-~lr - !
(Stree! and Numbsr) `
FORT PIERCE, SAINT lUC1E COUNTY, RORIDA i
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 emptoyment
at former domicile, removal of family to new domicile, purchase of home, etc.)
i
r ~o ~No REC~~ /
O~EACPO Tll~au'
CIERK C~RCuIT COURT ~~f ;
RECORO vERiF1E0 ~
~ ~s z ~rN~~i
~'~s~
~
~
:
~
~
~
3
~
z
~
b
~
~ I FURTHER CERTIFY that I will comply with all other ~equirements of a legal resident of this State.
~
~ 1 FURTHER CERTIFY that 1 have no intention to return to my former domiG~e, and 1 intend to remain in FQRT
~
~ PIERCE, SAINT IUCIE COUNTY, FLORIOA, permanently.
~ '
~ ' ~ y~~''`%•~,, j..,ti ~ ~!~/~~o%.
~ _ _'~a'`-}cGi~. me ~/~~.v1G ~
~`'lo
~ • . . • i . • : . --7
~ . . " ;z • .-Y ~ / ( •~l.s,i /q i -
:.R~'. ~'-l ~ (Address)
_ . 'h.
}•''a~
•
s~ ~ r' " r'r x, y y•v e ~ -______~_•~=~t~
Swan`tb and subscribed befo~e me this day of . 19~i
~ '
ROOER rO1TRA5 -
= LERK CIRCUIT COURT Notary Public
r' g ~ 1,`C D.C. My Commission expires
- Y
:~;y
_ (To bs ~xecuted in dupliute and ori~ioal filed with ClKlc Circuit Courf, and dupliut~ with Tax Assessor.)
w ~3 ~ SOOK~~ fA~E~~
- - ,
~ , ~
~ .
:
- _k -