HomeMy WebLinkAbout0185 2542'76
Declaration of Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
_ , _ COUNTY, FLORIDA:
This is my drelar~tion of Domicilc and Citizenship in the State of Florida that 1 am filing this day in
accordance, and in conformity with Section ~22.17, Ftorida Statutes.
1 was fbrmerl le al rtsident of
Y d 6 ' , and 1
(city) (stace)
r~sided at 1
L~ L~u'~~~ . Howcvt r, f have changed my domicile to
(Street and Number) ;
and am and have b~cn a bona iide resident of the State of Florida since -~-z day of
, 19~, and 1 reside at -~~s ~ ,7 ~ ~
~ G'~~~ (Street and Number)
_ ~L . County, Florida,
(cicr)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
• (Inseri here any pertinent facts, such as sale of prupetty or business, or relinpuishment of employment at formet ~
domicile, removal of family to new domicile, purchase of home, etc_)
/f-~~u !
' 254 '76
~ +
fIlEO Ak~ RECOROED
. ST. LUCIE ~~t;NTY fLA.
ROCER POTTRAS
CIERK Ctt:CU:~ COURT
RFC:~P.G ~EF:'=SEO.~..~.~. i
M~r ~ ~ a~8 eH , i
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~ 1 FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
~
~ comply with atl other requitements of a legal resident of this State. ;
P ;
~ I EUIZTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in ~
~ • ~,,.~'-¢~t.P-Gr -c.c-.~G.~
, County,
€ Florida, permanently. ~c~eY> ~
~
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i .G , _ • l,'` - ~rLtft. Q~ (Name •
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~ ol • : ~ ~
( • = (Address) ~
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~ ~'•.~yy.Q`rn_~o anc~~iscribed before me this day of •
~ 'c~.~^1-1-,•~ A.D. 19~~ ~
e ~
s
~ ~t_.c~cc~ ~p O'c
a _ r
; ~ No Pablic ate f~lorida at Large '
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; My Commi;sion expire _ ~ ~I~ s
f ~
w. ~
~ (To executed in duplicate and originrl filed w•ith Clerk C'vcuit Coutt, anJ dupluate with Tax Assessor)
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