HomeMy WebLinkAbout0837 Deciaration ot Domicile and Citizen~hip
TO THE STATE AND COUNTY TAX ASSESSOR, ~'t~~Q
Va~ C7
Sl. LUCIE COUNTY, FIORIDA:
This is rny declaration of Domicile and Citizenship in the State of Florida that I am filing fhis day in ~ccordante a~c1
~n conformity with Chapter 222, Sectio~ 422.17, Florida Statutes.
1 was formerl a I al resideM of ---~~~~i~,e!L~Y1~-------------- - _
Y e9
(City) (State)
~ / However 1 have changed my domiCile
and 1 resided at ~L~'_~__ . ~ -__~„l,~~
(St and Number)
to and am and have been a bona fide resident of the State of Florida since - =~~s~ day of ~
~ i
- 19~~, and 1 ~eside a1 - -
t
(Street and umber)
FORT PIERCE, SAINT LUCIE COUNTY, FLORlDA
and this statement is to be taken as my declaration of citizenship, actual lega) residence and domicile in the State of Flo~ida.
(Insert here any pertine~t facts, suct~ as sale of property or business, or ~elinquishment of employment `
at former domicile, removal of family to new domicile, purchase of home, etc.)
TO ESTABI,ISA I,EGAL RESIDENCE AVD ENTER CHIZDREN IN SCHOOL
~ ~J ~ ~
~
f~.EO AM3 RfCOASE~
. sT_ LIiC1E C~UNTY F1A. '
R06E'r. ?0lTRwS
CLENK C~~:CU~T COUR~
• RfCORO'~F~.F;EO
A~c t~ li 3s AH'1t
,
23~68
i
~ ~
~
~ `
~ .
~ ~
I FURTHER CERTIFY that I wi{I comply with al) other requirements of a legal resident of this State.
1 FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
PIERCE, SAfNT LUCIE COUNTY, FLORIDA, pe~manently. T$EL1IA Ii • HOBB$
(Name)
. ~
J ~ 1 L+~~4,. . i
, ~ ~Q G~~•~~ G , ` i
~ 4 : ryv~' ~ C~
~ 'P~
: ~ -
:
- ~ ~ '~G~:
~ _ * _ , • j ~ Address)
~ . - '
: M~: ~ : • ;
~ S•~n d~j~~ribed before me this 7~ day of , 19~ ~
%
ClE CC'~ ~
,
ROGER POITRAS
CLERK CIRCUIT COURT Notary Public
8y M- D.C. My Commission expires
(To be executed in duplicate and original filed with Clerk Circuit Couri, and duplicate~with Tax Assessor.)
~
, ~ooK205 ~~E 837
-
~ . ~ -
_w .