HomeMy WebLinkAbout0928 Declaration ot Domicile and Citizenship .
2334~9
TO THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in ihe State of Florida that 1 am filing this day i~ actordance and
~n conformity with Chapter 222, Section 222.17, Flo~ida Statutes.
I was forme~l a I al resident of ~'E ~~R T N~
Y e9 ~
(~ity) (State)
/?~„~~,~pa~ _ 2 iy' o~o~ ST .L. T
and I resided at _ Howeve~ 1 have changed my domitile
(Street and Numbe~)
~ .
-
to and am and have been a bona fide reside~t of the State of Florida since ~S day of
~ 1/. s~,~~~?~ - ~'T f~~7ec~ ~A-
- Y - - - 19 and I reside at • °
~ (Street 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 propery or business, or ~elinquishment of employment
at fo~-me~ domicile, removal of family to new domicile, purchase of home, etc.)
~.L~c~c.~li4r~ s~ :N~~rf -
2334~~
s~~Ul
?1E G4UEMTY fLA.
ROCER POITRAS
CLERR CIliCU1T COflRT
RECQRD YERIFIED..,~..~
J~t II !2 s~ PM'1i
; ~
~
I FURTHER CERTIFY that I will comply with all other requirerttents of a legal resident of this State.
I FURTHER CERTIFY ihat I have no intention to return to my former domitile, and 1 intend to remain in FORT
PIERCE, SAINT lUCIE COUNTY, FLORIDA, pe~manently.
- - ~ ~ .
. ~
~ - (Name) E.u 4 F.vE S,o~ ?.v 9 no
, . • 'a ~ r,•
. . , : ~
~ • ` . ,o~ .(!e ?.s,.o J.-. ~r ~F.acE /7
. < • (Address)
;
' , :
~ G~, ~ ~
. Sworn to and su~scribed before me this f day , 1~~ •
` ROGER POITRAS
CI UfT COURT Notary Public
By ~ O~ . My Commission expires
(To bs euecut~e! in duplicaM snd o~gina! fil~d withUO it Cou J~ duplie~s with Tsx Asiestor.)
g PAGE 9
No. 13 A . -
_ ~
_ ti
_ g`~ - r
> > ~..,~e"~~.~*'~,.._~'~ _
~ ~