HomeMy WebLinkAbout0260 - - i
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t~~cl~r~tio~ of Dornicile ar~t~ Cttizen~hip ;
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TO THE STATE AND COUNTY TAX ASSESSOR, `
s~ i uC~F coUNTY, FLORIDA: ~
This is my declaration of Domicile and C+tizenship in the State of Florida that I am tiling this day in accordance and
in conformiiy with Chapter 222, Section 222.17, ~lorida Statutes.
1 was forrnerly a legal res+dent of ~•~QrC~ _ _ ~a
, (City~ {~fifiiej ~
and ! resided at _--_-~2 ~11e~8 ~~t--------------_---- _ _ _ _ . Nowever 1 have cr~anged my ~omic,ile ~
~ (Street and Numbe~) ~
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to and am ancl have been a E~ona fide resident of the State of Florida since _ day of
- - 2 f_ ~2 , ~nd ! res~dc a~ $13 Daymon Ave., - - -
(Sireet and Number)
FORT PIEPtCE, SAINT LiICIE COUN?Y, FLORIDA
and this statement is to be taRen as my declaration of citizenship, actua! legal residence and dnmicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquisl-~ment of employment
at former domic+le, remova) of #amily to new domicile, ~urchase of home, etc.)
Hats liv~ here since 191~2- Jarnes ~ Ha~res is a sheet ~rorker and ;
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only leave~ tom to cio ~ p~rtictilar ~ob sta~ping ab~ut 1~ or 6 month~ and
~ then re~urns to Ft.pierce,Fla.
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. Ee RQ~D ~
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•~~~~~'~`,•~.~i~.=•,.~~ablishing residency ~ %~~(-':~'~y~B~OK
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; f FURTHER CERTIFY t~at I will cQmply with al! other requirements of a legal resideni of this State.
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? I fURTHER CERTIFY that I have no intention to return to my former domiCile, and t inter.d to remain in FORT
j PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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f , J\ ~~r'• :i•~•6~~' ~~I ~ ~ ~
~ ~ • , (Name? , ~
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; •.v_ L=:~~ f 'I.•t ~ tJ ~ L Ll'.~.Y~s
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J:l~_,~•.~4.:~,~t~ • - ~ (Address)
~ `G(t'a .....•''~~~./r`~~
;;;'S ~ Jannarsr 66
,~+!p,~,td ~and s~bscribed before me this day of , 19 ,
ROGER POlTRAS
RK CIRClJIT AURT - Notary Public
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~ $Y D.C. My Commission exp~res
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(To be executed in ctupticate and original filed with Clerk Circuit Court, and dupticate with Tsx Assas~or.j
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