HomeMy WebLinkAbout0303 ~ec~arati~r~ af Domicil~ and Citi~enship ~
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TO THE STATE AND COUNTY TAX ASSESSOR, ~
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Sl. LUCIE COUNTY, FLORIDA: ~
This is my declaration of Domicile anc~ Citizenship i~~ ti~e Sta~e of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
Ba1l.more~ Lotig Is~ar~d Nex Y oa~k
I was formerly a legal resident of
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(City) (State)
and 1 resided at ~~8 Midt~ood Avenue . However I have changed my domiGile
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(5treet and Numbe~)
to and am and have been a bona fide resident of the State of Florida since day of
~~,~t 65 23t~o N l~4th Stroet
. 19-____., and I reside at -____-___-J_
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(Street and Number)
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FART PIERCE, SAINT WCIE COUNTY, FLORIDA ~
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and fihis sfatement is ta be taken as my detla~ation of citizenship, actua! legal residence and domicile in ihe State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employm~nt
a; ic~mer domicile, removal of family to new domicile, purchase of home, etc.)
FILED AN~ EC DED
- ~C13 300K
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E~tablishing rasidsnae '~o JA~d 3 Ph1 2: 13
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t•_,`is',: :v;,, f~OG~i-; :-;-~:,3~. CLERK -
- S7. LUCIE CDUi~! i Y,
. ~ ; : ~LORIDA
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; I FURTHER CERTIFY that I will comply with all other requirements of a lega) resident of this State.
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I FURTHER CERTIFY fhat I have no intention to return to my former domi~ile, and I intenc~ to remain in F(JRT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
. . - - ~ I~~-~~i,
C-~
} . (Na e)
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- . . ' ' RAbert A. tboper & ~t Helen M. t~aoper
. - (Address)
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~ Swom to and subsuibed before me this 3 day of - J~~~ , 19
ROGER POiTRAS
LERK C CUlT CAURT Notary Public
gy D.C. ~ My Commission expires
(To be exeeuted in duplieate and original filed with Clerk Circuit Court, and duplieate with Tsx Astessar.)
BCOK ~35 303