HomeMy WebLinkAbout0661 - - _ . _ . _ _ _ _ _ - - - - _ . _ . _
De~ciarati~rr of Damicile ~ndl Citiz~nship l`~._1 1;; '
(
TO THE STATE AND COUNTY TAX ASSESSOR, ~
Sl. LUCIE CUUNTY, FLORIDA: _ '
's
~
This is r;~y declaration of Domicile and Citizensliip in the State of Florida that I am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
f was formerly a legal resident of . _ _ _ ,
i~+iesl - - x. I~-----
(City) (State)
4
and I resided at ._R_ F_ D ~ BoX ?3 . However I have changed my domi~ile ~
(Street and Number) ~
to and am and have been a bona fide resident of the State of Florida since _ 24th day of
sugust_ b5 206 So ~l~th Strset }
- - . 19- - , and I reside at - ~
(Street and Number)
FORT PIERCE, SAINT LUCIE GOUNTY, FL(~RIDA
and this statement is to be taken as my declaration of citizenship, actual lega( residence and domicile in ihe State of Florida.
(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.)
Establishing residency ~
~
i
FIL~.AN~~EC~RDEd °
- icia-- pco i
0 0 K ~
'~s ,lg•'~1 ~ ~ ~i4~ ~ ~ : ~6
i~1.s~~~•~
1 `~-.l~J_1 u • .
F?GGi=~• ~'-.I •.LERK ` " • ~
LU~!`..c~; i Y • ~
u~~ , _
FLOftIDA - : ~ ~ -
~ ~~'t ~ : ,
? : ~ ~F.
~ _ .
: i`.
? ~ - ~ ~hl'M't.. . -
~
e '••..r~~•'~~~_ 3`~
_ .,?''1.~:,.n,``:~.
j I FURTHER CERTIFY tha3 1 will comply with aU other requirements of a legal resident of this State.~~~'"~~~~s~`~~"'
i '
i
~
: I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and 1 intend to remain in FORT ~
' PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. r
. . ,,_,•,~i4; ~ , _ - ` }
: ` , S
F~ ~~~4`~~ ~ ~y/
~ -
._a ,~»t•• ~
= : Y~-.:,~: . .
~}j°~•:'~ . willism (Nam~) Hotea
. ~ ~ ;
. . ~6. , ,
;~A~: ~r:.., . ~ d c~j
: , ~ t7~ , : 4 r
i ' f- ~ ` } I ~ . ,
: :}d , . ~ ~ . ~ . . '
. i ; t, ~a_ :l.,_'i', ~ v Y
' s r
t ~ r'~ f(/ B@3 ~@ ( ~0~,@S
.~~'~'J~,', ~
~~~~~i:fiiiltLl.\ ~ - -
Sworn to dnd subscribed before me this llth _ day of - d~nUBi'y 9 ~
ROGER POITRAS
' RK CIRCUIT C URT Notary Public
~ ~G~r..lc.G~-~
By D.C. My Commission expires
(To be executed in duplicate and original filed with Clerk Circuit Court, and dupticate with Tax Assessor.)
; 800K ~~7b eJ~