HomeMy WebLinkAbout0514 D~clar$~ion o4 ~omieile ~nd Citig~n~~tip
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TO THE STATE AND COUNTY TAX ASSESSJR, ~ ~~~i~ ~
Sl. LUCIE COUNTY, FLORIUA: ~
This is my declaration of Domicile aiid Citizenship in ttie State of Florida that I am filing ihis day in accordance and ~
in conformity with Chapter 222, Section 222.17, Florida Statutes. j
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Philadelphia 4 Pennsylvania j
I was formerly a legal resident of ---.----__---_--------:-----Q------- ~
(City) ~ (State) ~
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3234 N. Phillips Street ~
and 1 resided at - However 1 have changed my domiCile
(Street and Number)
to and am and have been a bona fide resident of thQ State of Florida since -4--__--- day of
Octo~er 65 620 Coconut A~enue, River Park
19----, and I reside at -
~ (Street and Number)
F6RT PIERCE, SAINT IUCIE COUNTY, ~LORI~A
~nd ihis statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida. ;
(Insert here any pertinent facts, such as sale of property or bu~iness, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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~ ' ~ - ~ FILE~ AND RECORDED
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; - . _ s66 JAN ~ AM .1~~.~33
~ . . B~tablishing residence ~3 s~
_ RaGEf; ~=(iI k ti:~S. CLERK ~
; ~ ~ ~ 5T. LUCIE COUNTY.
FLORIDA
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~ I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
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I FURTHER CERTIFY that I have no intention tv return to my former domi~ite, and I intend to remain in FORt
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~ - ~ ~ ~ ~ ~G~-
~ ~ ~ " (Name)
~ ' . . ~ - Ado 1 ph F . We i ge l ~
, . . i
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~ . ~ . , (Address) ~
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' Sworn to`and subscribed before me this 7 day of - Janua~ ~~q 6~
ROGER POITR~?S
CLPRK CI lllT CO RT Notary Public
gy ^ D.C. My Commission expi~es
(To be executed in duplic~te and originsl filed with Clerk Circuit ~ourt, and dupliate with Tsx Assessor.)
gonK 135 5~.4