HomeMy WebLinkAbout2518 . ~
~ !
De~laratian ot diomiclle and Citi~tensl~ip ~
. - ~ ~ :131~5~ ~
~ TO THE STATE AND COUNTY TAX ASS~SSOR, ~
~
ST. WGE C~UNTY, flOR1~A: ~
• ,
t .
This is my declaration of Doniicile and Citizenship in ihe Stat iorida that I~m fiting this day In otco~dartce and
in conformtty with Chapter 222, ~ection 222.17, Florida Statutes.
i
1 was fo~merly a legal resident of il ' '
~
(Ciry) • (Stato) 1
~ , ~ ~ ~
~ end 1 resided at ~ ~ Howevar ! hava changed my domlCJle j
~ (Street and Number) ~
~ ~ ~
~ to and em end have b~en a bo:~a fida residant of fhe Stata of Florida since day of ;
y7: i ~Q
~ ~ ~ • 30 J ~
- , 19~ and I rest~ie at ~ ~ ~ ~
t (Street and Number
~
~ ~ FORT ~1ERCE, SAINt LUCIE COUNTY, FtORiDA
~
~ anci this statemant is to be taken as my daclaration of citizenship, actual legal raaidence and dcmicite in the Stero of FIo~1da.
~ ~
~ (insert here any pertinent facts, svch as sale of property or business, or reilnquishment of empicyment
~
~ at former domicile, removal of family to new domicile, purchase af home, etc.)
~
~ ~
~ ~~~%y~~p'~~~ ~4 ' n . .
' F ~7s'~+(,'\.~ ~
ty •
~ ~
~ !
i'. 1
,
:~a.~~~J4 _ t
s~ ~
; . ~ p pND ~~CO~DE~OK . ~ . ~ ~ o ~ ~ ~ • _ . .
~ q~~~......, , ? ~ .
'
~t ~ca~i 1.. . ~ . ~ : .
~ ~ . ' ~
; IN - . . ~ ~
;
. EC ~9 PM ~ . 2 . ~ ' -
- ~ ~~~'4 ~ ~ c~~.c~K ~ ~ • '
~ ~
; . Ro~ER ppiTRaS~1.OR10A. . • ~ _ ~ ,
~ L~CIE C~~N~'I • 1,`- $i~ ~ ~ ! ~ ' '
_ ~ S1. ~1,~ .~i ? . ~ ~ ~ ,
i
: . . . s
, i
~ I
, ~
1 FURTHER CHtTiFY that I wilt oampiy with all other raquirement: af a(eq~t ro:ident of this State. ~
~i ~
, t~ . .
I FURT~iER CERTIFY that I have no intention to return to my former domic~le, and ! intend to remain In FORT i
PlERC~, SAINT LUCIE COUNTY FLORIDA rmanentl .
~ . . . pe, . y _ ~
4 . . ~ . . ~ ~
~ ~ e
~ • t {
~ y~ ,
~ . . (Nnme r
:t - -
. t
~ ~ ~~e~
~ ~ - _ 30/ ~c~~:~c~ ~
~ ~
~ ~ (Adslr~~? 3 i
} ~ `t +l ~ ~ ~ ~ ~
~i~ r~~ ;
. ; . ~r Syv+pn, ~'ar~! :e~bseribed befora ma th~is dny of , ~q~, ~
"',i ~ ~ ` • , ~
' ` ',~f
~OGE~ ~ItRAS - i
~ ' i
, ~j ~!ti•:. CLERk ~tdRC COURT ' . Notary Publk {
.
BY D.C. IV1y Commiaaion expires ;
_ ' ~
. : ~ j
- . - i
~ Ro b~ ~x~eut~d in e~piteah aed oripi~ ~1~l: apd dupUcat~ wilb tax llt~or.) ~
: ~ Bb~~~U.t. ~F~c~ l. . ~