HomeMy WebLinkAbout0353 Decl~r~tion ot Dc~rv~i~ile ~nd Cit~~~n~hip
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TU TNE STATE AND COUNTY TAX ASSESSUR, ~
Sl. LUCIE COUI~lTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statufes.
D~roit - _ Miohigan
I was formerly a legal resident of _ _ _
(City) (State)
8l~2b Trinity `
and 1 resided at _ Howsver 1 have changetl my domiCiie
(Street and N~mber)
to and am and have been a bona fide resident of the State of Florida since __~3__
- - day of
~u 65 Z10l~ ~ e ~trost
- - - ~l.(-5 ~ 19-----, and I reside at
(Street and Number)
f~RT PlERCE, SAlNT LUC16 C4UNTY, FLt~RIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in ihe State of Florida. ~
~
ilnsert here any pertinent facts, such as sa(e of property or business, or relinquishment of employr~ient . ~
at former domicile, removal af family to new domicile, purchase of home, etc.) ~
~
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!66 J11~~~ y A~9 II: 18
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~stablishing re~idence _ ROG~.i; i°U+ i ~i ;S. CLERK ~ ~
-ST. ~UC~t COUNT~Y. ~
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I FURTHER CERTIFY tnat I will comply with all other requirements of a(egal residenf o~~'t~4~~
~~~fie;,.,'' ;
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`O~ I.Fi::S~, -
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1 Ft1RT!*iE,R~ GERTIFY that I have no intention to return to my former domiSile, and-I int~nd-.~Q',t~~air~` in FORT
. r~, _
PIERC~,.~SAI~P~$~iU~~e~CUUNTY, FLORIDA, permanently. ~
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~ ~ -+i~~..:_~y j~.w~'L`~-• , --~""T~~~~
' , :,ty'>_~ _ (Name)
_ ,~~_.~.-,~:,~,-3~.~
,
- . ~ .
' ~
• Ni~ma Koistinen
• (Address)
Sworn to and subscribed before me this ~ day of - d~~'' _ l9^~
ROGER POtTRAS
CLERK CIR IT COURT Notary Public
Sy D.C. My Commission expires
,
{To be executed in duplicate and origina) fii~d with Clerk Circuit Gourt, and duplicate with tax Assessor.)
~ $ooK 353 -