HomeMy WebLinkAbout2243 ~i ~
Oecla~ation ot Domiciie and Citizenship
T~ THE STATE ANU COUNIY TAX ASSESSOR, . •
51. LUCIE COUNYY, FIORIDA: 261822
This is my decieration of Domicile and Citizenship in the State of Florida that 1 am filing this day in acto~dance ar?d
in conformity with Chapter 222, Scctio~ 22?.17, Fforida Statutes. .
1 was formerly a legal resident of • ~ J//j'~~S ,1L,r~ R~ ~V
(Ciry) (State)
and I resided at ~~_ltJ . Nowever 1 have changed my domiv~e
' (St~eet and Number) ~
- ~ ~
to and am and have been a bona fide resident of the State of Florida since ~7~~~ ~ ~ day of
' ~~~uST , 191~, and 1 reside ~at ~ ~~5~ Ct.~/~~STrizp T~ 1~'~ S~li ~c/'4-
(Street and Number)
FORT PlERCE, SAINT LUCIE COUNTY, fLORIDA "
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicite in the State of Florida.
(Inse~t here any pertinent facts, such as sale of p~operty or business, or relinquishment of employment
at fo~mer domicile, removal of family to new domicile, purchase of home, etc.) ~
Applying ~ for Homestead /~o r~ S~ .l ~
- Entering children in school ;
% a ~ y''~ ~r~Ic~~e ~ .
. ~ .
~ _ ~i'Pa~~.-C~ ~!'/~Zi4-cl~e, ~
' - ? ~ra ~FC4~oEa
• ~ Rd
£R a~MTY F~,
' . CLERK CFF.GW~A~S L
. nFCeac vE~rfiEp ~DURt -
~ 10 11 s9 ~ ~T 3
; . 2s1822
; -
~ I FURTHER CERTIFY that I witl comply with al) other reqvirements of a legal resident of this State.
i
~ •
~
~ I FURTHER CERTIFY that I have no intention to return to my former domic.ile, a~d t intend to in in FORT
~ PIERCE, SAINT LUCIE.COUNTY, FLORIDA, permanently. -
~ _ -yl~-t~'-~t,~-~.~uu~
F ~ ` ~ i
! y`- "
~ ,,~~~~~~~n~~s~j~ ^r'H~'L ~ ~Q..~! ~e. ~ C ~e f~ r(}.
` -•'GU1T~`C0
p !j ' J (Name) . H-
; - ~ , . ~ ~ ..s < D~r rr+ ,
'C~;~e~J p~•~~+G:,+
-:~rt - ~
: ~ ~ ~ - w ~ : ~ ! ~ V O ~ GL~ l / 7~ S ' fZ'~ /r?~ ~ ~ ~/GI ~ -
. i ~ ~
? cA „ , ; ~R~ i': _ (Address)
~ , ~1 :~~l.:.t R~•J V ~ i:a , -
i . i~ N ~ • . ~ .
I'~
; ~ J ' :
` Swoh~,J~bi'bd~~~~ed„before me this ~ 0 day of ~ ~q ~
~ . , r!.•,•~~?t~i~~~ . ,
~ ~ , . -
; ROGER POITRAS
~
CLERK CIRCUtT COURT ~ Notary Public
~
s •
s QY ~ U D.C. My Commission cxpires
a
3 eeox z1~ ~acFZ~~ ~ .
~ (Yo be oxocuted in dupticato and or+~inaf filed wilh Gcrk Cercuit Couti, and du~licafo wilh Tax AssessorJ
z.
~~,M . . y ' ~
- ~ . .~w . _ - . ~~~~*-.r:~s