HomeMy WebLinkAbout0854 OeCiaration ot Domicile and Citizenship 2,~161 ,
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TO THE STATE AND COUNTY TAX ASSESSOR, • ~
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Sl. IUCIE COUNTY, FLORIDA: ~
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This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance ar?d $
~n conformiy with Chapter 222, Section 222.17, Florida Statutes. f
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. I was forme~ly a legal resident of __~~~4~__'~l~Q-~
(City) (State)
and I resided at _~r$~.~~~o~ ~ However I have changed my domitile
(Street and Number) `
to and am and have been a bona fide resident of the State of Flo?ida since _ day ot
E1-
l~ y ~
- - - - 19_L~, and I reside at ~ ~ 3 d ~~2~2-~q . - -
. (Street and Number)
PORT PIERCE, SAINT LUCIE COUNTY, FLORIDA pQ~ c~~' ~ w C,~'2.
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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 tormer domicile, removal of family to new domicile, purchase of home, etc.)
. - 225161 ~
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FILED AND RECORQ~ _
ST. ~UCIE COUNTY F '
~ocEa Po~T~?a #
CtERR CIRCUIT COURT
RECORD VERIF{ED~~
I!~ 1 4 0~ PN't2
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~ I RIRTHER CERTIFY that I will comply witfi all other requirements of a leyal resident of this State.
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~ 1 FURTHER CERTIFY that 1 have no inteAtion to return to my for domic,ite, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, perma~ently.
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~ : . _ - (Name)
- - L, G. Osborne
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= - ~ ~ ~ _ ~ pQOdat~c v~ i f e
- ~ ~ ~ _ Hele.n D. Qabcrne
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f 'Sworn.to ~nd subscribed before me this day of ~fl1.~_~~~v , 19~x!
`fi ROGER POITRAS
~ GIRCUIT COURT Notary Public
By ~'~u~ D.C. My Commission expi~es
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rr Ro b~ ~x~cvtsd in duplicab and ori~inal fil~d wiN~ CIKIc Ci~cuit Court, and duplicaf~ with T~x Ass~ssor.)
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