HomeMy WebLinkAbout0500 4
Decla~ation ot Domicite and Citizenship ~
~~szz
~ TO THE STATE AND GOUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORiDA:
This is my detlaration of Domicile and Citize~ship in the State of Florida that 1 am fiiing this day in acoordante and
in conformiy with Chapte~ 222, Section 222.17, Flo~ida Statutes.
~
,
I was formerly a legal resident of
(City) tate) ;
and I resided at _ However I have changed my domiti~e
(Streef and Number)
to and am and have been a bona fide resident of the State of Florida sinte _ _ day of
_
- . 19~~ and I reside at ~~ct-~'y~-~ a[J~,~------
(Street and Number) `
l
FORT PIERCE, SAINT LUCiE COUNTY, RORIDA ~
(
and this statement is to be taken as my dectaration of citizenship, actual legal residence and domicile in the Stete of Florida.
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
t
I~~E
R[CORD VER Pj~p aQU~T ~
M~ ~ 3 ~1 PM'~Z
~
E ~s~
~
3
~
~
~ I FURTHER CEftTIFY that I will oomply with all other requi~ements of a leflal mside~t of this State.
~
€
~
~ 1 FURTHER CERTIFY that I have no intention b return to my former domiCjle, and I intend to remain ~in FORT
~ PfERCE, SAINT LUCIE COUNTY, FIORIDA, permanently. ~A$ T. ROCHE
~ ~
s
F ~
1~
~ ~
` ~~etlM NN{q/~~~, (Name)
~ - ~ ^ ~~i
s . ' d ~ - ` . • , .
.s . : '
_e~ ' Z"~ ~~df@SS~
_ . . ~ W r ` ; i': , ~ .
z ~ . • . • ~ / ~ .
~ Sworp-to "aryd~~ribed before me this f day of 19~~'-
Y: - ._....•r , ~ '
v
3 ROd~ `M~OfTRAS
-
= CIRCUtT COURT Notary Public
% ~
By D.C. My Commission expires
.
~ ~
ITo b~ ~x~e~d in duplicats ~nd ori~inal fil~d wi~l~ CM~ic qraiif Cou~t, and duplicat~ with Tax Ass~or.)
~ 'b. 13 a $Q~X ~ ~ ~
a
~ - - - - - - -
- - _
"~s~e~.
r~ ~ y _
~.~-x?~~~_..__ ~~..~.b.. .'~`_'r . - . ._-a.-