HomeMy WebLinkAbout0310 De~iaration of norni~ii~ ~nd Citiae~s~hip
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TO THE STATE ~ND COUNTY TAX ASSESSOR,
S~. IUCIE COUNtY, FLORIdA:
This is my declaration of Domicile and Citizenst~ip in the State of Florida that 1 am filing this day in accordance and
in conforrnity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of _ ~ _Utl~ol~ __8ity____,__ ! NeH JeI'S~
(City) (State)
1102 P~liBades Ave. . However I have changed my domiCile
and I resided at - - - -
. (Street and Number)
to and am and have been a bona fide resideni of the State of Florida since ____.__~9~__._ day of
---------Octob~r------------, t9~~_, and I reside at __7b2 Pr3~gViata Blv+~, Pt St.Lueie
(Street and Number)
FORT PIERC~, SAlP1T LUClE COUNTY, FIORIDA
and this sTatement is to be taken as r$y declaration of citizenship, actuai legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new dornicile, purcF~ase of i~ome, etc.)
r Fstablishing residency
~ FI~-E~ AND RECO.
~ Joint oKners to th~ houae ~N.-.._ ~~~~80 p
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+ . . . V ROST l- ~;J~T;~:~S ~IER -
~ -n r ~ LUC1E COUNi'Y K
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~ 1 FURTHER CERTIFY that I will cumply with all other requirements of a legai resident of this State.
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~ 1 FURTHER CERTlFY that I have no intention to return to my former domiCile, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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` (Name)
j' • • K~r~.i' Brockmann
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SWor~t to and subscri6ed before me this ~i'd day af JSr1A~ty' , 19 66 .
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R~G~R POtTRAS
RK CIRCUIT CO RT Notary Public ~
By D.C. My Commission expires j
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~ (To be executed in duplicate and origina) filed with Clerk Circuit Court, and duplicate with Tax /luessor.)
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