HomeMy WebLinkAbout2005 . Deciarati~n ot Domicile and Citizen~hip
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TC) iHE STATE AND CC~UNTY TAX AStif.~.SOR. %~~~448
':i. IUUE COUNTY, FIORIDA.
This is my declaration of Oomiute an:i Citiicn~hip in the Sta~e of Florida that 1 am fil~ng this day in accordance and
,r~ con(ormity with Chapte~ ?22, Section 222.17, Fi~r~1a Statutes.
I was formeily a legal reside~t of ~ Ill.~ T -
C ~~-~!~_l - - - W '~2~---- -
(City) (State)
and I resided at _`-f Y~G./~ ~r11~-------- _ Nowever I have changed my domiGle
(Street and Number)
to and am and have been a bona fide resident of the State of Fiorida since day of
d
~i _~.l_-~ , 19~?! and I reside at
- - y ~ - - - - J ~ a v ~ c~ - - _
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
,
and this statement is to be iaken as my declaration of citizenship, actual lega) residence and domicile in the State of Florida. ;
(Inse~t here any pertinent facts, such as sale of property or business, or relinquishmznt of employment
at former domicile, removal of family to new dom6cile, purchase of home, etc.)
Applying ~ for Homestead
Entering children in school :1~~
C hris ~ 1~11~ rYla r-~~~n Cc y C /O
~ e-~-h 1~1 ~ 11~ a r- ~,n i 3 .
sTiuc ~ couNn Fi~.
ROCEF ~OITRAS
CLERK Ci??CUIT COURT (
RECCP,~ VE~ F~ED n
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236448
~ FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ s~~5~wam do~r~i% ~tribed before me this day of . 19
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R~St;tR"P~ITRAS -
CLERK C RCUIT COURT Notary Public
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6y ! - D.C. My Commission expires
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i (Ta be executed in duplicate and original filed with Clerk Circuit Court, and duplicafe with Tax Assessor.)
. ~ ~ ooK 205 ~~~E 2005
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