HomeMy WebLinkAbout2257 .
~
DeClaration of Domicile and CitizensEifp ~
#
r .
TO THE STATE AND COUNtY TAX ASSESSOR, ~
51. LUCIE COUNTY, FIORIDA: i~rs183~
This is my dccla~ation of Domicilc and Citizenship in the State of Florida that 1 am filing this day in actordante and
in co~formity with Chapte~ 222, Scction 222.17, Florida Statutes. .
. , ,
1 was fo~merlY a legal resident of
(City) (State)
end 1 resided at 1~~~ ~ _~~d' However i have changed my domiCile
' (St~eef nd Number) ~
to and am and have been a bona fide resident of the State of Florida since day of
19_~;% 2, and I reside ~at '
~ (Street and Number)
FORT PIERCE, SAINT lUC1E COUNTY, FLORIDA
and this stateme~t is to be taken as my decla~ation of citizenship, actual legal residence and domicile in ihe State of Florida.
(tnsert he~e any pertinent facts. such as sale of property or business, ar relinquishment of employment
at fomner domicile, removal of family to new domicile, purchase of home, etc.) ~
Applying, for Homestead - ~ .
- y~Entering children in school : ~
. . ~~%I?J
~(Y.G%K,.('~'L ~
~L~~~
C.l-GL~u~ (.i~"''w
GC.~_
.
f1LE0 Al~r~ ~:C4ROE0
ST_ LNCiE CQt~NTY ~lA,
CIfP~~~;CJl7 C~pURT ~
26183~ ~fCOP.D YER~F~ED.~~
~ Auc 18 i 48 PN '73
i 1 RlRTHER ~ERTIFY that 1 will comply with all other requirements of a legal resident of thfs State.
~ ~
;
; 1 FURTHER CERTIFY that I have no intention to return to my former domic.ite~ and I intend to remain in FORT
E - "
F PIERCE, SAINT;~,lj~~lE'~ ,TY, FIORIDA, permanently. "
~ U ! T - C ~ ~
~ e .
G 4~3
` ;
`'V~~yvii~~~,y~'•-pG~ ,
~ . ~ . - /c+•, ~~J .
; ~ ; [-1~.~~ ~ G ~ ~ . + ~ '
~ ~y,,.• , ; Q;: (Name)
' : v~l , -
_ s•,. a
: . ~y Ej _
, j••f ~:'~~~+6•"~ ~ ~
~ .
1 ' ~ ~ ' U/ L~ ~ ~
~ . ~ '
' . (Address) -
` ~~j~,~'~~•• '..S
' }~r~f~lt!tllt!`*~~ •
~
~ Sworn to and subscrib fore me this - ~O day of , 1q~~ `
t ROGER PO{TRAS
4
s CLERK CIRCUIT COURT Notary Publ+c
f ~ • . ~
aY D.C. My Commi;sion expires
= ao~217' ~22~ ~ ~
(To be oxecutcd in duplicate and oric~inal filcd w+Ih Clerk Circuit Court, and duplicato wilh Tax Assossor.)
i
~
_..r_.~ _,r_L_ ` ~ ` ~
- ~
a'; _