HomeMy WebLinkAbout2913 Declaration ot Do~nicile a~d Citizenship ~
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TO THE STATE AND COUNTY TAX ASSESSOR, /V~7Irr I SS
Si, IUGIE ~OUIrITY, FLORIDA: '
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This is my decla~ation of Oomicile and Citizenship in the State of Florida thst I sm filiny this day in eao~dante and ~
in conformity with Chapter 222, Section 222.17, Florida Statutes. ~
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1 was fo~merly a legal resident of I~~~i~~ !
(City) (State) ~
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and I ~esided at ~v~-~eS ' . However I have chanyed my domicjle ~
(Sirest and Number) ~
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ro and am and have been a bona fide resident of the State of florida since day of ~
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- _ , 19~~, and I reside at ~ 3 ~ ~ ~ ~
treet and iVumber) ,
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FORT PIERCE, SAINT WCIE COUNTY FLORIOA ~G` F ~ G_ w~~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida. ~
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(Inse~t he~e any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, pu~thase of home, etc.) ~
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C~Yn~~~~xy ~~~--f °i~`' ~~~4E~IE COt~fMTY flA.
IIOGEF ~OITRAS '
CIERK C~~:CtlIT CCURT G '
RfC~Rv" V'~ FIEO ;
Ju~ 6 I`l ~o PN'~Z
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~ I FURTHER CERTIFY that I will aomply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicjle, end I intend to remain in FORT '
QIERCE, SAIfKT. LUCIE "~OUNTIf, FLORIDA, permanently. ~
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- ~ N i~`L.L~ G'y%[~.L~l.tv :
~ ~ - ' ' (Name) G s e r r' S a /ri q~
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, ` L~'Z~PJ /~-~LiLIV
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~ Sworn to and suburibed before me this day of , ~q~!
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~ ROGER POtTRAS
C K CIRCUIT COURT Notary Public
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aY D.C. My Commission expires
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(To b~ ~xecut~d in dupliut~ snd ori~inal filed with CI~rIc Gra~it Cowrt, and duplicat~ with Yax Ass~sior.)
,3 A ~00~203 ~a~2913 ~ ~
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