HomeMy WebLinkAbout1767 ' 225803 Y ~ ;
Declaration of Domlcile and Citisenshlp
TO THE STATE AND COUNTY TAX ASSESSOR, `
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Sl. LUCIE COUNTY, FIORIDA: ~ ~
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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 and ;
in conformiry with ~hapter 222, Section 222.17, Florida Statutes. '
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I was formerly a legal resident of ~.Q~L~~ L---~~--- ;
(Ciry) (State) ~
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and I ~esided at _--~~5 - ~~~-_.-_`~~E~'~ , Howeverl havechanged mydomicjle ~
(Street and Number)
ro and am and have been a bona fide resident of the State of Florida since .~1~,e-~MQE~ day of
~G'-C~E.R I/7(, Si4y5 N ~I~ ,~~T / O S ~
- _ 19---, and I reside at - - - - -
(Street and Nur:~ber)
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. ~
(Inse~t 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.)
~~I~eNAS~~ ~ C"oitJJJi~f I~Vi~! ~ Ar A8o ~ F. ~DD~C~S S
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o~~ ~o~w~Y ~
~ aocER Po~ta~a
CLERK C~RCU~T ~~U~ ~
; RECORC YE~~~~E~
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~ 1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
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~ I FURTHER CERTIFY that I have no i~tention to retum to my former domic,iie, and I intend to remain in FORT ~
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~ PIERCE, SAINT IUCIE COUNTY, FLORIDA, permanently. ~jOHN I,. ~?ILZS
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:,q (Name)
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' ~ • ~ t/~6 ,qy.~yo(~_ ~~e~v~ L~n~ ios-
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- -$worn to and si,bicribed before me this ~ 7 day of , 19
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ROGER POITRAS ~
~ T COURT Notary Public ~
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8y ~ D.C. My Commission expires ~
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= (To b~ ~xscuhd in dupliut~ snd atipioal ~iled with tlKk Grcuit Court, and dupliut~ with Tax Ass~s~or.)
ho ~3A BGRK~O P~CE1 (66
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