HomeMy WebLinkAbout0284 t'~eclaratian ~f i')~mfcile a~nd Citi~en~hip ° _
TO THE STATE AND CUUNTY TAX ASSESSOR,
51. iUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizensl~ip in the State of Florida that I am filing tliis day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legaf resident oi g~8t_H~p~Ori _ ~0~1 YO!'~C
(City) (State)
and I resided at _a~_R~a _ _ _ _ Nowever I have changed my domi~ile
(Street and Number}
b and am and have been a bona fide resident of the State of Florida since _____.__2_._-______ _ day of
Septanber ~ 65 Route 2B~x 2763-15~ Laketaood Park
- 19---, and I reside at
(Sireet and Number)
FORT P:ERCE, SAINT LUCIE COUMTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and dnmicile in the State of Florida.
(Insert here any pertinent facts, such as sale of ~roperiy or business, or relinquishment of employment
at forme~ domicile, removal of fami!y to new domicile, purchase of home, etc.)
l.~~~-~D At~D REC RDED
~~L'#~t~~-~a~A~' OOK
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stabliahing r~sidenca f~~~ 't~~.~?;~~
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' I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of ;tFi~~'.fiit~f!!4`"~ ~ ;
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~ - I FURTHER CERTIFY that I have no intention to return to my former domi ile, and I intend to remain in FORT
~ _
' PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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•,3 ~ ~ (Name)
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_ ~ t~ _ , - T~$lliam Meno~er
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- - • (Address)
~ L' ~ ~ `~I ~ : ~ ~ 3 January 66
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'~'6avit'i~n;~~~d;sukiscribed before me this - day of , 19 .
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RUGER POITRAS
LERK CIRC COURT Notary Public
By D.C. My Commission expires
(To be executed in duplicate and original filed with Clerk Circuit Court, and duplicate with Tax Assessor.)
~opK135 ~84
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