HomeMy WebLinkAbout2626 - ~%~b416 '
Declaratio~ ot Domictl• and Citlz~nship ~
TO THE STATE AND COUNTY Tq?X ASSESSOR,
Sl. lUC1E COUNTY, FIORIDA: ~
This is my declaration of Domicile and Citizenship in the State of Flo~ida that I am filing this day in accordance and
~n conformity with Chapt~r 222, Section 222.17, Florida Statutes.
.
1 waa formerly a legal resident of -----Q P -7~ ~~/C~ ~
(City) (State)
and I resided at _1 ~ However 1 have changed my domiGle
(Street a~d Number)
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to and am and have been a bona fide resident.of the State of Florida since day of
. 19-,! U and I reside at _~_~~_~-T~(~
(Street and Number) i
t
FORT PtERCE, SAINT LUCIE COUNTY, RORtDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(lnsert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at fo~mer domicile, removal of family to new domicile, purchase of home, etc.)
)
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226416
fILEO ~qfD RECOR
=t. ~~~E couNTr
ROCER POITRA=
CtERK CIRCUIT COii ~
RECORO VER~fIEO
'i lIAR 19 ~1 rt
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' I FURTHER CHtTIFY that I will aomply witfi all other requirsmants of a le~al resident of this State.
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~ i FURTHER CERTIFY that I have no intention to retum to my former domicjle, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently_ ~ '
~ I,EWI S R . HUGHEY ~ ~ / ) ~
' ~'RANCES C . HUGHEY ~1~~
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- Swqrn~tp and s~bscr~tXd before me this ~9th day of Yarch ~ 19 ']2
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'~r~` ROGER POITRAS ~ ~
= RCUIT COURT Notary Public !
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By D.C. My Commission expires
(To b~ unaN~d in duplicah aed or+~nal flbd wi1i~ Cl~lc Circuit Courf, and duplicat~ with Tax Ass~ssor.)
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