HomeMy WebLinkAbout2500 . ['::Gl.~t< <~~~t~ c.?~ C:Ct,i~.:ilc. .<t~•:i (:i:i:'~:tt:.l;in
lU THL STl11L l~NU CUUNIY 1/'.~ !~'.•:•!:.'•t~F;, . ~,51688
51. LUCIE COUN1 Y, FIORIDA:
lhis is my declaration of Domicile and Citizcnsi~ip in tha State of Florida tliat 1 a~n lilinc~ ti~is day in accordance a~d
in con(o~mily with Chaptcr 222, Section 222.17. Flarida Statutes. ~
.
1 was former) a Icc al ~esident of ~
Y J
(City) (Stato)
~ , ~ ~ -
end I resided at K S~ . Howeve~ 1 have changed my domiCile
• ' (Sfteet and Number) •
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~u and am and have been a bona fide ~esident of the State of Florida since day of
~ ~ .
? o~ ~I !J ~
19~?~, and I reside 'at ~ ~ ~ +
Q (Street a~d Number)
s
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA ~
and this statement is to be taken as my decla~atio~ of citizenship, actual legal residence and domicile in the State of Florida.
pnsert here any pertinent facts~ such as sale of property o~ business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, ett.)
Applying, for Homestead _ ~ -
- - Entering children in school : ~
~ FIIED ANO RECOROEO
~ C I~ fl~ • ST. WCiE COJNTr F~A.
- ROGi„ rJ1iRAS ~
~ ~ \ • I ~ \ ' CLEpK C:~:,Uti COURT
~j R`c^~~ v` ^~`~'o
- ~ ~ ~ . . ~ aPR ~ o ~ ~ oa AH ~73 ~
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- ~ ~ 251688
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i FURTHER CERTIFY that I will comply with al) other requirements of a legal reside~t of this State.
I FURTHER CERTIFY that I have no intention to ~eturn to my former domi~ile, and I inte~d to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
~ ,
_ ~ ~ ~ ~ ~ ~
V ' ~ pG ; ~ • (Name) o ~ d
.~`~tiy~~j±G~~1-/,~ . ~
~ S ~ . y / ! ~ / ~ , ~
. _ ~ ~ ~ : {1 - -
- - . ~-r}~ ` (Address) . -
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~'Sw,qf~},
~p~~l~d~subscribed before me this v day of , 19~!
cst
~ . . .
ROGER POITRAS ~
CLERK CIttCUIT COURT Nota~y Public
.
ny _ D.C. ~1lly Commission cxpires
~ eoo~21~ ~~t-2501 ~
(To bo oxoculod ~n duplicato and ~•~~~~al ~il~cl wi11~ Clu~k Circuit Courl, a~.J duplicalo with Tax Assossor.) ~
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