HomeMy WebLinkAbout2492 Declar~tion of Domicile and Citizenship :
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TO THE STATE ANU ('OUNTY TAX ASSESSOIt,
ST.._ ___Lucie _.______COUNTY, FLORIDA:
This is my dectaration of Domicile and Citizei~ship in the State of Florida that I am Ciling this day in ~
accoreiance, and in conPormity with Section 222.17, Florida Statutes.
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I was formerly a legal resident of a r G K. z? , f~'1 ar.s • and I ~
f (citr) (State) ~
resided at 10~ ~i-4ri~ . However, t have changed my domicile to
(Stteet artd Numbet)
and am and have bc~en a bona fide resident of the State of Florida since 2 g~~ day of
- /a?p*' ` ~ , 19?Z and I reside at ~ ~ ~'kel ~LD ~ 1
~ /Ces ~ (Street aad Number)
S~a k: t /~ar ! J~ Q~~~ , S~,~ t,c c i~ County, Florida,
(citr)
a~;d this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(Inseri here aoy pertinent facts, sucA as safe of property or business, or relinquishment of employment at former
domicile, removai of family to new domicile, purchase ot Aome, etc.) _
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FILED AMO RECOR
ST. ~({~IE COU11t1? ~
Establ~sY_in residence ROCERPOITRAS ~
g CtERK CIRCUIT COUAt
RECORD VERIF~EO
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I FURTHER CERTIFY that 1 will register at my local address when the registration books reopen, and
comply with all other requirements of a lega! resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intertd to remain in
~~r~ rc ~ .S~T ~ ct e I c County,
Flari~a;'~tmapently. cc'~r~ ' ,
, Zv~TL . . rr, c•J; ' .
+ A~r'~!.'~ Peter J. Z i ~
" G - A spiK:
f ~ La /c~„r
~ 'vT.U~'n ~1, ~ - ~1iG~'~S ~ ~a k t ~`o?! ~ic r'ct ~i-_
: ~ 'Y _ ,'v (Address)
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Sw~rh'~U+3~'~,~tt'bscribed before rn~ this -_~1'aay of
M~ y A. D. 19 ~ Z.
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Notuy Publie Stsl f Florids st Large
My Commission expires ~~__t~-_~~`~
~To be ezecuted in duplicate and onRinaf fded with Clerk Circuit Coutt, snd duplicate with Taz Assessor)
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