HomeMy WebLinkAbout2093 ~ ~ {
D~ciaration ot Domicil~ and Citizenship ;
TO THE STAYE AND COUNTY TAX ASSESSOR, A~~~S~ ~
51. IUCIE COUNTY, FIORIDA: {
This is my declaration of ~omicile and Cilize~ship in the Stete of Florida that I am filing this day in attordancQ ~nd
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal reaide~t of ----_f~!_~ ~G'.~'
~C~ty~ ~ (State) ~
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and 1 res~ded at ~_?_1_~__'_ _'_~N~~L! `~~~'d - However I have changed my domiCile
(Street and Numbe~) ~
to end em and have been a bona fide resident of the State of Florida since _~l day of
7/ g/
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G- - - - . 1 and I reside at ~Ll~~ T~tiJ~•{'L` ~ L!//?~O /`i-1//3/J - - - _
(Sireet aRd Number)
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FORT ERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, ectual legal residence and domicile in the State of Florida.
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of ernpfoyment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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iT.IYqE COUNT~ /tA.
ROCER POtTitA~
CLEftK CIRCYtt COWIt
• RECORD YEAtf~ED
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~ 1 FURTHER CE~tTIFY that I wil{ oomply with afl other nquir~ments of a leyal resident of thls State.
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~ I FURTHER CERTIFY that I have no intention to retum to my former domicjle, and I inte~d to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. GEORGE 1~'. RI'~PEIiL ~ ~
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(Name) ~
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-~,;i C~~.,,~
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- s Swq?n t6' s~d ~ljbuc~eci before me this day of , 19~1--
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- COURT Notary Public
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`~~a By ~ D.C. My Commission expires -
a`
~Y~ Ro b~ ~x~cvt~d ie du~liut~ arwl ori~inai f~ wilb CINk Cirwit Co~r~, and d~pliut~ wi~h Tax Ast~s~or.)
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