HomeMy WebLinkAbout2589 . Q~clar~=iian ot Rorc~icil~ ~sc~~i Citir.c.~n:,t~i~n
~U TNE STA1C AND COUNTY Tnx nSS[S,SOft, 251~54
51. lUC1E COUNTY, FIORID~:
This is my declaration of ~omicile and Citizc~ship in thc State of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Settion 222.17, Florida Statutes.
'~_I/_ ceC - ~~a
1 was forme~ly a legal resident of ~~11~~
(Ciry) (State)
~
and 1 resided at However I have changed my domiCile
~ (Street and Number)
~o and am and have been a bona fide resident of the State of Florida since day of
' /~~P~ .
' and 1 reside ~at ~ p.~.~-' ~
- ~ (Street and Number)
~ .
FORT PIERCE, SAINT LUCIE COUNTY, FLORIOA
and this statement is to be taken as my decla~ation of citizenship, actual legal residence and domicile in the S1ate of Florida.
(Insert here a~y pe~tinent facts, such as sale of property or business, or relinquishment ctf employment
at former domicile, ~emoval of family to new domicile, purchase of home, etc.) ~
`~PP ~
. a~~l~?~~ ~or Se~n~c~rg~~~~ ~ ~
f ~Ep UMD
~
" ;~~~QEit p~~M?f
' CLERK C~RCWT ~~~~5
I~' ~ ~ itECOR@ VfR?~IEO
_ . - _ - 8 ~9 ~'~3
f ~
~
~ - 251'754
I FURTHER CERTIFY that I~vill comply with all other requirements of a lega) resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
PfERCE, SAINT LUCIE COUNTY, FLORIDA, pe~manently. -
. `
; I- ` ~ .
~ pG•, / .
•'j ~ . ' ~ ~ • (Name) ~ I~ e d C+ r c ~ ~
• ;'~2~ • . . -
~ G; ~ ~ x .
~ ,1• .j y , ~l• mb~• ± , ~~O [ If~( ~
~ ~ •
, i ~ ~~~a.~
~V : (Address) .
r•~' ~ . i
~ Syvom to and subscribed before me this day of ~ . . 19~•
~ - ~
ROGER POITRAS
CLERK CIRCUIT COUBT Notary Public
,
.
_ [~y _ _ ,~1 _ O.C. My Commission cxpires
1Nif~~~
! (To be uxocutod an duplicate and ~~al fil~J wilh Clerk Circuit Cour1, and dupliute with Tax Assossor.) ~
~
~ V; ~ ;
s -r; z, ~v~ 4 x ~ x
~l _
.:.yl^,s