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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