HomeMy WebLinkAbout2941 Deciaration ot Domicile and Citizenship
TO THE STATE AND COUIVTY TAX ASSESSOR, IG:Ii4534 .
Sl. LUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in actordance and
conformity with Chapter 222, Section 22~.17, Florida Statutes.
I was formerly a legal resident of s~1~~_ ___I__v1l
(City) (State)
~
and I resided at _ C~~ 5T~ ~~~X l7 However 1 have changed my domiGle '
:
(Stre~t and Number) i
~
~
to and arre and have been a bona fide resident of the State of Florida since ~~y r71 ~ ~ l_~ _ day of ~
a
, 19-__ , and 1 ~eside at `3~ S~ ~
- . !
- - - - _ . f-~-y-,~~X S
(Street and Number) s
2
i
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 property or business, or re{inquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
:
q ~}'jv v CS d ~ ~ - P~ ~ r_ rc Q, F-c L,. 2~ ~ 7 L
E ~
i ~
! }
f
t
P
's, ~~ltlD~~pR~
~ ~OGfcii ~OIT~ y`~
~ 6i£u ~fRCtIfT CO[!~T
~Et01M 1?ER~f~~l~'~
Y ~ ~ , • ~3
k ~ ~ ~2 ~
q ,
~ ~%~4534 ~
~ ~
o-
~ ~
i
~ ~
~ }
S
~h '
~ {
~
~ I FURTHER CERTIFY that I will comply with all other requirements of a le~al resident of this State. '
~ ;
~ :
I FURTHER CERTIFY that I have no intention to retum to my former domiule, and f intend to remain in FORT #
PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently. t
rs
:
_ ~
~s ~ - ~
- , (Name) ~
- E
~
,:t.. ~y" ~ /.~io ,
. . ~
; ~--~-_S 1~ s'` ~
, . (Address) g
_ ; r. ~ ~
_ • ~
_ _ Swwn to aru~t 6scribed before me this ~ y - day of ~ r 19~~- '
.
_ ; F
~ ; ~
_ " .....-.a•'r ;
- ROCER "POtTRAS
CLERK CIRCUIT COURT Notary Public
:
By D.C. My Commission expires ~
~ t
,3=; ~
(To b~ ~x~cut~d ie duplicah and ori~inal ~iled witb CIKIc Grcuit Court, and dupliut~ with Tax Ass~s~.) ~
_ ;
,
,-3 • {
;~i~ ~,o ~ ~ A gpR!c FnCE