HomeMy WebLinkAbout0966 ~ ~
Qeclaration of E~omicilc~ and Citixenstti~
10 THE S1ATE ANU COUNIY TAX ASSf~50k,
235652
5l . LUCI[ COUN I Y, (LnRIDl~
lhis i~ n~y ~l~~e~a~ati~n of O~mic~le an~ Cit~T~:~s}~ip in tl~~ State of Florida ~h,~t 1 am fi~ing this t?ay in ~ccortisnce and
:n wnfor~~~ity ~vith Chap'er 222, Section 2?2.17, Floric~a Statules. ~
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I was formerty a legal resident of ,.~~~~L~lc~~~~_ _ _.~~~G1
(City~
y~C~ (State)
.:nd 1 resided at Cr' GL~~7_L._ _~LG`~~~1(~_ _ _ . Hawever I have chanyed my domicile
(Street and Number) ~
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to and am and have been a bona fide resident of t~ie State o( Florida since day_ of
- C~ '
_ - 19~~, and I reside at ~~21 /~~~/~~~16iL~..--1~,~-„(~~: , .Ct~
(Streei and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is ~to be taken as rny declaration oi citizenship, act~al legal residence and domicile in ttie State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicite, purchase of home, etc.)
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FtLEO AliO ~ ECORDED ~
S1.lUC1E COUNTY FIA.
' ROCER POITRAS
CIERK C?~t:,WT COURT ~
RECORO VEp'F!EO~..~--
Auc !8 2 3s PN'~Z
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I FURTHER CERTIFY that I will comply with all other requiremenis of a legal resident of this State.
1 FURTHER CERTIFY that I have no intention to return to my former domic,ile, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently. AZICE . PETERSON
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i S~p ~a~s~Acribed before rc~e this - day of _ 19~` .
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~QO~T~tAS'
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~ ~''GI,ER ,GNt~~U T COURT Notary Public
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~ Ey ~ O.C. My Commission expires -
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~ (To bo executed in dupticate and oriyinal filed with Clerk Circuit Court, and dupliwto with Tax Assessor.)
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