HomeMy WebLinkAbout0425 ~eciaratiear~ ai Dorrricile ~r~d Citizens~ip ~ ~
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TO TNE STATE AND COUNTY TAX ASS~SSC~R, -j-~~- ~
Sl. LUCIE COUNTY, FLORIDA:
This is my declaration of Oomicile and Citizenship in the State of Florida that I am filing this day in accordance and
in conformity witti Chapter 222, Section 222.17, Florida Statutes.
Pittsbnr~ ~ Penn~rglvan3~
I was formerly a legal resident of _ . _ - _ _
(C+ty} (State)
271 Jonquil P'la ee However I have chan ed m domi~ile
and I resided at - - - _ . J Y
(Street ar~d Number)
to and am and have been a bona fide resident of the State of Florida since - day of
123
~9___b5 and 1 reside at _-_-_12~ $oneto Court~ Port St. Lucie
(Street and Number)
FORT PIEEtCE, SAINT I.UCIE COUNTY, FLORtDA
and this statement is to be taken as my deciaration of citizenship, actual legal residence and dornitile in ihe State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of emplayment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Establishing residence '
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~ I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
i 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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~ t_~ -j; (Nam
~ . a - . . .
i - - . ,
~ ' ' ' Theodore J. t~i.llen
r ' `,j (Address)
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~ , Y 47 ~ _ ._L~,.' .
; . ~ ; 5 danuary 6b -
i Sworn to and subscribed before me this - day of - - , 19 .
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ROCER POITRAS -
CLERK CI UIT COURT Notary Public
gy ~E" D.C. My Commission expires
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+ (To be executed in duplic~te and original filed with Clerk Circuit Covrt, and dupliute with Tax Assessor.)
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