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HomeMy WebLinkAbout4879 Dectaration of Domicile and Citizenship "TO THf; STATt: ANU C•ovN~~ti' Tr~X ASSl:SSOR. ;~r~4~g3 St. I,ucie . (•OUNTY, f=LORIDA: Thi~ i~ my ~lcrlaratiun ot~ Uomirilr an~i Citiz~n~hip in th~~ Stat~ of florida that t am tiling this day in arcor~f~ncr, and in rantormit~~ with Section '?'.1 Florida S[;itutrs. 1 was fonncrly a le~;a! rrsid~ni oC I?'_~~~Y~l~~_ _ _ _,_,?~?E~jlPSSe3r~-- and 1 (ci~>• ~ (state) _ _ r~sidcd at '023_ Niller ~ve. , Howcver, 1 havc changed my domicilc to (Slr~~t anJ Numbrr) and am aud h:~v~~ brrn a bona fidr r~si~rnt ot thr St~tc of Florida since -2~_-_--- day of Dec. . I~) 7~. and I reside at 2-78---DSarin~_~~~.-~a--#o--~ea~~ (S~rret and Numbet) _i - - Ft . ri e rce_ - - • - - - c-~.---I.usi e County. Florida, - - ~c~~.~? - a~id this statement is to bc taken as my declar;~tion ot~ citirenship, artuai legal residence and domicile in the State of Florida. (Insrr. hrrr anc prrtin.nt f~cts, such as wlr of pruprrty or huci~ert~, ur rrlinyuishmeM of employmrnt at former domicile, rrmu~al uf family to ne~v domicilr, purchru of humr, rtc.) ~atablis'~ing reeidence 24488~ FIIED ANO kECQ_~iDED ~ ST.IUCIE COUNTT F~A. ROCER ?O~TRAS CLERK CfRCUIT COURt RECORD VERIFIE~.~.~..~ ,~w 3 3 39 PN'13 r~ w ~cv ~ 1 FURTHEK CERTIFY" th~it 1~~~il( r~~~istrr at m~~ toral addrrss «~hen the r~gistratior~ books rcopen, artd romply with atl other rcquinmrnts c~f a t~,~at rrsident of this St~te. 1 FURTHFR CERTIt=~" tL-at I h:i~•: nc~ int~ntiun to rcturn to m~~ t~orn~~r dvmicile, and ! intrnd to remain in Ft. Fierce - _ . S~.,Lu~i..e__ . _ ('ounty. Flurids, pt rman~ ntl> . - « ? _ _ ~ ~ ~ ~ , j, c ~ , - • • ~ J. ~ - _ a; . - - J aeph Paul 3~a jea' ~ r)St' - ~ ~ - - - '~.'t 1 Addre~til Sworii tci •atid suhs~rih~d hrlc~r~ mc thi. 3 ~l.t~~ ~~f Januar~~ ..a.t~. t~~ 7: _ ~t_~l<--c-y ~Q~?~ ~~-~r - N ry f'uh6c S[a[r Ilf FIUI1,:! JI l ar_r ~t~~ ('c~mmission r~~irrs J~r,u~r~ 15 ~ 1976 ( in hr r~rcu~cJ in Ju~~h..~[r anJ ~~nciu.~l fdad .~ith t'Irrk ('inuit C~~urt. ~nJ JupG:atc w~th Tat .~l,cussori ° Rkzo~ FL~C; ;r,~: ~,~'j ( . : ~ _Y..~ ~ . _ _ ~ - ~ ~ :