HomeMy WebLinkAbout0096 Declaratlon ot Domicil• and Citisenship ~ ~ ~
. ~
TO THE STATE AND COUNTY TAX ASSESSOR, ~~~Q~
Si. WCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
- /GL. Coac7
I was formerly a legal resident of ~/Q~ T!~L` - -
(City) (State)
/B ~~o ~'~0~~/ c t ~D .
and I resided at ~ However 1 have changed my dom~c.~le
(Street and Numbe~)
to and am and have been a bona fide resident of the State of Florida since . J F'e`r day of
JC/L ~ B/3 S• C. VyLt.£y ~O.
_ 19,z~, and 1 reside at -
(Sireet and Number)
FORT PIERCE, SAINT LUCIE COUNTY, fLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida. ~
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of farrtily to new domicile, purchase of home, etc.)
~ ~,o6/,.s.C. r'SP~
~°o~~~a~~.
Q~ERK CtRCUIi
RECOR~ VERIflEO
1 z ~ ~1z
; -
~ 232897
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1 FURTHER CERTIFY thst 1 will oomply with al) other requirements of a leya) resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domic,ile, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permarsently.
N......... . • ~
~ GUi j '
V~KSiiUM''''~vL -
(Name)
~
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~ • ~ ~ ~~..1
O.
~ s A Ct 3 S E. c AL L E y~D,
~ j ~ (Address)
J
Gc~E CO•;M~~~
~~+~~'~rrorn to and suburibed before me this ~ day of , 19~
'
Y
Roc~e roin~?s
CLiRK CMCWT COURT Notary Public
By ~~-~C. My Commission expires
, ~
(To b~ sx~wl~d in duplicab ad ori~nal Hl~d w~ Cl~ic Circuit Co~rt, and duplieat~ w~h Tax Ass~or.)
!io. 13 p ~ ~
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