HomeMy WebLinkAbout0158 De~claratian of Damicile and Citizenship
TO THE STATE AhD COUNTY TAX ASSESSOR, ~~9
St I~ticie _ COUNTY, FLORIDA:
This is my deciaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in
accordance, and in conformity with Section 222.17, Florida Statutes.
1 was formerly a legal resident of YOnrOe ~ ~iichigan and I
(citr) (Statej
resided at H~l~~od ~Z.i r~ . However, I have changed my domicile to
(Strcet and Number)
and am and have been a bona fide resident of the State of Florida since l~t day of
~ort S~. Lucie
l~o~eaber , 19_~_, and I residc at ~088 O~irbrooY Drivs
(Strest snd Number)
~'t. Pierce , St. Zucie County, Ftorida,
c~ir)
and this statement is to be taken ac my declaration of citizenship, actual legal residence and domicile in the State
of Florida. ~
(Insert he~e any pertinent facts, such as sak d prope~ty ot business. or telinquishment of employraent at fama
~.::e:i.'e. znssura! of fa~ily tn ~tw domicile, ourchase ot home, etC.)
~
st~.
u°c~E cou~iiY Fi~.
Establiahing re~idence ROCERlOI7RA9
CI.ERK CIfiCUIt COU11T
RECOR!+ VEPIFIED...,~,~.
M~r 5 !1 a9 PM'~Z
- ~
~
~ 1 FURTNER CERTIFY that I will r
egister at my local address when the registration books reopen, and
comply with all other requirements of a legal resident af this State.
~ 1 FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
~
~'t. Pieree St.Zucie
' Flp~id~;. ~c~~r~ , County,
~ ~fert~t.anently.
_
~ Li . ~ ~
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! _ . , ~L Q + (Nsme)
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; 11
.
' ' Irene Str~'e~c~ier
.
..~r~'~;ttl'?n~iaubscribed before me this __~h day of ~~uurn,,,~
e . ;
; - ^ l[a A. D. 19~ :~~~~```.~,~~:~«:•3~1~y
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GLe~~ ~0~~ ~i¢ ~
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i ~ Notuy Public State of Fbrida st Large J«, ";i~~!~e'-`~ p~-
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; My Commission expires a-w• / , . ~ . ' v
_ :'~`~6? :
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' f. .~S7A'tE ~.~~L-~
I (To be e:ecuted in duplicate and ori6inal fded with C1etkC~i11~'/~i~~~t~ictt~ with Tax Assessot)
~ ~~02 n~ 1 : _ i~
~ ACO F rm 1 22 }
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