HomeMy WebLinkAbout0134 ~ Dectaration o! Domicite and Cjtizenship
10 THE STATE AND COUNTY 1AX ASSESSOR,
Si . IUCIE COUNI~Y, FtORIDA~ 23'~'372 i
~
;
~
This is my declaration of Do~n~cile and Cifize«sttip in the State of Flo~ida that I am filing this day in actordance and
~n coniormity wi~h Chapter 222, Section 222.17, Florida Statutes.
1 was forme~ly a legal ~esident of __QX~~___11~1L -
(C~ty) (State)
and I resided at .~t~~.r''~__~ _~~~~~i~~!~~~ However I have changed my domiCile
{Street and Number)
to and am and have been a bona fide resident of the State of Florida since c~1_ S~____ day of
! . 19_!_!~ and 1 reside ~at _L~3 l~4f~J~~?`~' ~ '
~ ~ ~ (Street and Number)
FORT PIERCE, SAINT LUCIE GOUNTY, FLORIDA
k
an:i this statement is to be taken as my declaration af titizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sa!? of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Applyingj for Homestead ~
Entering children in school :
~c ~u A
~ ~ S /~iv.U. (f~(/i ~~/~lv ~ ~ U ~
~,b~t p,~u~. (cv,~/~~t} ~~~,~du.~~.
fitEU A?~9 RECWtDf~
Lti~~E COUl~~ f~.I~
~s~~t r"v~T~ l ~;Ofi"
CLE~iR C.r.•,;u~+ ~0liitT
~ RfCO~C ~t~. ~-'ED.~,~L~
'I .
S~r ~ 9 ~i AH'~Z
~ _
i
i 23~3~2
~
I FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State.
1 FURTHER CERTIFY that I have no intenlion to return to my former domi~ile, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
,~~~..,~u~...... ~ ` ~
; ~ J t i t.''•.
C1 Vv:~~•, O -r--
_
• t ' ~ (Name)
~ _ ~ • :
~ %
o:~ °
t
.
~ -,•"'i o _ ~03 ~ru,~s
:
~ ~ ~ ~ ; Q?': (Address)
~ GC~
~'''..,,,E C 0
~ SwoF{~ ~o and subscribed before me this s-~ day of -`~t~ , 19 ~Z
~ ~
~ ROGER POITRAS
~
~ CLERK CIRCUIT COURT Notary Public
~
~ gY 1~~="- D.C. My Commission expires
~ (To be executed in duplicato and original filed with Clerk Circuit CouM, and duplicate with Tax Assessor.)
BJOK2VS PA6t ~c~, ~
- - - -
- . ~ A
~
-