HomeMy WebLinkAbout2221 DeClaration ot Damicile and Citizenship
1p. THE STATE AND COUNTY TAX ASSESSOR,
261806
51. LUCIE COUNTY, FIORIDA:
This is my detlarotion of Domicile and Citizenship in the State of Florida that i am filing this day in aoo~orda+~oe and
in conformity wilh Chapte~ 222, Section 222.17, Flo~ida Statutes. .
. • P ~Y o r~-
I was fornnerly a legal resident of
(Ciy) ~
1 ~ . However 1 have d~arged ~*q/ do~*~iGac
and 1 resided at ____Q______
• (St~eet a~?d Number) - .
to and am and have been a bona fide resident of the State of Flo~ida since f~~~
t~ S~ , 19~, and I reside 'at . ~ 1 L k`5 t~ L t( C~' ~
(Street ar~d Nu )
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA -
and this statement is to be taken as my decla~ation of citizenship, adual legal residence and domicile in the State of i~'ida-
(Insert here any pertine~t facts~ such as sale of property or business, or relinquishment of ~
at fo~mer domicile, removaf of family to new domicile, purchase of home, etG)
Applying~ for Homestead ~ -
- ~ Entering children in school : I
. P~- w - -
~ - . ~ ; ~ ~
~
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- c~~e e~~,ceut u~rr ~
REtOR~ t/fR'rlEO~~..~
~ - ~ Zi 9 ~e W'~3
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I FURTHER ~ERTIFY that I wil) comply with all other requirements of a lega! resident of this Staie.
1 FURTHER CERTIFY that I have no intention to return ta my former domicjle and 1 intend to remain in FOitT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. I~'~AR/~7~N Q. r1'C a-G Z~/1~'S~'~ ~
~ `
• (Name)
{~~~iS~Lk.s
~
t s f ~ rl
(Address~ _
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• p, G U/T.,,~.. ~ :
.
Sw~ot~j1A:.~qSK~?~scribed before me this ~ ~ day of 14
. _y G.~".`~ -
- :`~~R•~P~TRAS
: ~ ~ ~T Notary Public
~ . ~ .
n~ =tis • ~ Q
Qy _ D.C. My Commission expires
. ~ d00K ~7 P~E
(To bo oxecuted in duplicato and oriqinal filed wilh Cierk Circuit Cour~, and duplicate wita Tax AssessorJ
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