HomeMy WebLinkAbout0349 - _ - . . ~
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~eciaration ot ~ot~icile and Ci~izer~~hip
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TO THE STATE AND COUNTY TAX ASSESSOR, ~.i, ~
:i_l~:l r•3 7
Sl. LUCIE COUNTY, FLORIUA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing ihis day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident c~18T1 a.13fII _ _ _ - .
(City) (State)
and 1 resided at __3l7 HaY'ding Ave. . However I have changed my domiCile !
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(Street and Number)
to and am and have been a bona fide resident of the State of Florida since __Q.t21 _ day of
~!ey l,~.p~ Colonial Road
- - 15~~--, and I reside at
(Street and Number)
FORT PIERCE, SAiNT LtJCtE COUt~TY, FLORIDA
and this statement is to be taken as my declaration of citizensliip, actual legal resirience and domicile in the State of Floride.
(I~sert here any pertinent facts, such as sale of properiy or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
F'I D REC
Establishing residence ~r'~ ~1G~d~_f~ - R~EQ
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_ ? N ~ _ ST- ~U~'I~ COU~,~TY,~,l, ~
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1 FURTHER CERTIFY that I wil) comply with all other requirements of a legal resident of this State. ~
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I~URTHER_ CERTlFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT ~
PIERCE, SAINT.,;L~}~~~;,(,-,OUNTY, FLORIDA, permanently.
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`i • (Name}
~ ; . . - Gladys B. Bnrnett
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~ (Address)
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Sworn to and subscribed before me this ~?th _ day of J~L~I'y' , 19 bh .
ROGE~ FOITRAS -
RK CIRCUIT C RT Notary ~Public
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C~ D.C. My Commission expires ~
(To be executed in duplicate and originat filed with GRerk Circuit Court, and duplicate witfi Tax Assessor.)
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