HomeMy WebLinkAbout2204 ~ . . . ` ~ i
[~e~I~wation ot Domicile and Citlz~nst~lp . . ~
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TO THE STATE AND COUNTY TAX RSSESSOR,
Sl. IUCiE COUNTY, FtORIDA: ~ '
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am flling thit day in acoordente and
in tonformity with Chapter 222, Section 222.17, Florida Statutes.
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1 was formeily a legal resident of - (Stats)
(City)
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rQ idad et ~~~~3 f~-~~-~-"-~ - - . Mowever 1 have chengad my domlr~la
. and 1 s
(Street and Number) ~
' b and am a~d havo been a bana fide re~sident of the State of florida since day of
~o y ~d ~
, 19 , and I reside at -
- , (Street and Numba~), .
~ ~ !°ORT PiERCE, SAINT LUCIE COUNTY, FLORIDA ~
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and this itatamant is to be taken as my declarotion of citizenship, actual leqal residence at~d ~mielle in the State of Hwida.
(Insart here any pertinent facts, such as aale of proparty or business, or ~elinquishmenT of employment .
at former domicile, removnl of family to new domicile, purchase of home, ett.)
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. . ~1l.ED ~N~ R~CORDEDQK • • o ~
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~ • .41 'r
~ ; 1N..~~~ ~ ~ ; 4 . ~ o~ ~ ~~i-..~ ; ~ ,
~ ~ ~ DEC 2~ aN 10 ~ ~ ' ~ • ~ :
t964
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40~ ~ a ~ 1 • f ~ .
. ROG~R flOR10 ~jti,;~~~~4,,..
gj , lUC1E COUN~ Y. << r ~ ~
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~ ~ { Ft1RTHER CERTIFY that 1 will oomply with al) other requlremsr~t= of a le~a) resident of this SfiNe.
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f: ~ I FURTHER CERTIFY that i have no intention to retum to my former domidle, and I intend to rembin tn EOi~T
•~j ` PIERCE, SAINT lUCIE COUNTY, FLORIDA, permanentFy..
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, ; ~ , ~ j~ ~ ; • `Ir (Mame)
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; =.S'« "'`•;t. ~ 1: (Addr6s:)
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w.,,sy(a ~ e
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F . ~ I ;E; i~ ~ . ar~
a~~"~ da of 1
'Swarn to and subsc.~ibod beforo me thi: Y
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s' ~ ~ K CIPR~CU~COtJRT Notary Pubik
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~ ~ a~c~ D.C. My Commiuio~? expires -
~ - ~ ~ ~ aoR~ ~OG ~~~E~403
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~ (To be ~x~a+tad in duplkah ~~d o~e?~1 Al~d wilh Ct~lc prarit Couh, and d~pik.Ns wilb Tax AwiMS~.~
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