HomeMy WebLinkAbout0513 _ _ ^ ~._A _ _ ~
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~ecfaration ~t Dor~~cile ~r~d Ciliacetu~shi}~
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TO THE STATE ANO COUNTI' TAX ASSESSOR, b~~~.~
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i Sl. LUCIE COUNTY, FLORIDA:
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Ti~is is my declaration of Domicile and Citizenshio in the State of Florida that I am filing this day in accordante and
:n conformity with Chapter 222, Section 222.17, Florida Statutes.
" t was formerly a legal resident of __Tuppsr Lake _ New York
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(City) (Stat~)
35 PB.Y'k $tseet However I have changed my domiCile
and I resided at - - - - - - .
(Street and Number)
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to and am and have been a bona fide resident of the State of Florida since day of
D~Ce~bBZ' , 19 6~ , and I reside at .__._-?~a S 3th St1•88t
~ (Street and Number) ^
FORT PIERCE, SAIN? LUCIE GOUNTY, FLORIDA
and this stateme~t is to be taken as my declaration of citizenship, actual legaf residence and domicile in the State of Florida. ~
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(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment ~
at former domicile, removal of family to new domicile, purchase of home, etc.) ~
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~~1 yU REC~ RDEQ 1
TC~CI~t ~QCt1P~ ~ O K i
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Establishing residence -L~-~--~~l~
fti~l~~ '~~i i Lti~~K -
~T. LUCI` G~U~•.T'{,
~ ~ ~LORID~,
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~ ~•,.~~URTHER•~CERTIFY that I will comply with al) other requiremenis of a legal resident of this State.
F 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, psrmanently. -
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.j:t".I ' . . ~ ' .f~l~ ~ 3
y,• ( ame) ~
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~ . . ' . Leah H, ke8ves
~ ~ ' ~ (Address)
t - . . " 7 Ja~nuar~ 66 ~
Swar~:to and subscribed before me this day of _ . 19 • ~
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R~C;ER POITRAS
CLERK CI UIT COURT Notary Public
gy D.C. My Commission expires
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(To be executed in duplicate and original filed with Clerk Circuit Court, and dupticate with Tax Assessor.)
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