HomeMy WebLinkAbout1713 ~ Declaratio~ ot Domicile and Citizenshlp
~
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORI~A: '~25~66
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in atcordance and
~n co~formity with Chapter 222, Sectio~ 222.17, Florida Statutes. ~
.
I was forme~ly a legal resident of ~~i~ -
(City) (State)
- ya~y - ~y~ ~ . _
and 1 resided at , wever 1 have changed my domicile
(Street and Number)
ro and am and have been a bona fide resident of the State of Florida since day of
~ - ~ ~iP-/'~~~ -
-----L . 19~a and ! reside at ,
(Street Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
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 employment
at former domicile, removal of family to new domicile, purchase of home, etc.) ;
~ ~ g ~
~ ~ '
v
- ?
=L lUC
E COUNTY
CIERIKCChCU11 C~IlT ~
RECORO VERIFIEO'~ ~
f
~
' Mwt !1 I! 2s ~!'Tt
~
4
~
a
~k
F
~ zzs~ss
~
~
~ _
~
z I FURTHER CERTIFY that I wili comply with all other requirements of a leya) resident of this State.
~
~
~ ~ FURTHER CERTIFY that I have no intention to return to my former domicjle, and i intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, pe~manently.
~
~ '
~ ~
~v ~ ~ ame)~
~ - Si6•P ~
~ ` ' ~ •
. ~ . ~ ~ . . (Address)
!t =J • . ,
~ - ; L SworR to`and sub3cribed before me this ~ 7~ day of 19~2--
.
=a~ ~ ~
J~ . • , " •
~ : ;
~t04HC ~ ~ITRr?s
~ ' ,•'•~.G~tK ~IRGUI~ COURT Notary Public
c
~ 8y D.C. My Commission expires
r;
r~;
2:-
~ (To b~ ox~cuhd in dupliuh and ori~inal Rl~d whh Cl~k Cjrcuit Court, and duplicats wifh Tax Ass~swr.)
aocK ~ ~cf 1~~
a; No. 13 A
- . . _ _:`ri
. &.e~+-';
;
~ - -
4 ~~r.~-x ? ~ ~ . ~ y
~~~'~~'=~s a.~- ~_~~-~u_~a___,_ . ~ _
`~3rs