HomeMy WebLinkAbout2478 ~ '
• Deciaration ot Domicile and Citizenship
TO THE 5TATE AND COUNTY TAX ASSESSOk,
~l IUCI[ COUNTY, FIORtOA: ~411~1
This is my declaration of pomicile and Citize~stiip in the State of Florida that I am fiting this day in accordance and
~n conformity with Chapter 222, Section 222.17, Flo~ida Statutes.
I was formerly a legal resident of t - - ~%G~,~'------ _-_--_-~~'L1 -
(City) (State)
rs
and ! resided at T_~__~~..~~'l~fn~~f~~k(~--~__,________ _ However I have changed my domiCile
~ ~ (Street and Number)
J .
~ ~ p~~ ;
to and am and have been a bona fide resident of the State of Florida since ~~~_1-!~ y day of `
. ~ s
/ ~ /i/4' LGL/[.~'L~ L// 1'~' V F
- - ---~i , and 1 reside at f-.~-_~'L-{C' ~
(Street and Number)
~
FORT PIERCE, SAINT LUCIE COUNTY, FLORtDA
and lhis 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 property or business, or retinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
;
~
i
_ :
Applying ? for Homestead ~ ;
s
~
Entering children in school : ;
i
T LUC E C001~~Y ~
ROC~k rOtYAAS
CtFP.K C~'CUIT CO{1RT " ~ ~
. REr,OR~ v~~ =,~p `
~ t IZ i3 PH'~1 :
.
~ !
~ ~
4
~
_ - 24i131
1 FURTHER CERTiFY that I wilt comply with all other requi~ements of a lega) resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domiGle, and 1 intend to remain in FORT ;
,
PJERCE, SAIN7 lUCIE COUNTY, FLORIDA, permanently.
a
_ '7
• ~ - ~ : (Name) ~
' ;.l IT ~ = , -
' ~:5~
~
•~G?'', , _ ,
~~G;~~ J , .
~ / ~ p ~
• ; ~ ~~j.. 1 • ~ } / ~ ~ / l. / I ! l~~? L~.I /f""i •
~ " ~ ~ ~ - (Address) ~
' c,i: ' ~
_ Fi . 1''s.~~- : ~ ~ i
• 's-1'' % 7 : v ~ ~i
~ir,SWR[A•tv'an41~~<ubscribed before me this day of , ~q
, , --t--~ ~
r~ Ce.~ . .
` ;
- _ ~
` ROGER POITRAS ;
i
E CLERK CIRCUIT COURT Notary Public
; ,
; eY ~~~c- C~ D.C. My Commission expi~es
~ -
~
~
i (To be executed in duplicate and origina! filed with Clerk Circuit Court, and duplicate with Tax Assessor.) s
j
eooK2~7 rAC~2~7~
, , ~
- ~ ~ : ~ .5
_ ~.L~~..,~~~ .