HomeMy WebLinkAbout0696 D
D€~~laration ni D~mi~ile and Citix~h~hip? _i 1~j~~
TO THE STATf_ AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FIORIDA:
Ti~is is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
in canformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of Mt1T1.l3t8~ IridiBria
(City) (State)
2133 North De1aKAre rark~r
and I resicled at . _ _ _ _ _ _ . However I have changed my domi~ile
(Street and Number)
to and am and have been a bona fide resident of the State of Flarida since day of
~L1biLS t 19_- bs and I reside at --1~J~. _SOri8t0 COLil't
~ (Street and Number) ~
FORT PIER~E, SAIPIT LUCIE COUiVTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, ac'ual legal residence and domicile in the State of Florida.
(Insert here any pertineni 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.)
AN
FiLE q ~EG~ 900K
~~~_---~~u~
r
E~~ablishing resid~nce '~6 ~ ~
, '
, ~ ~ FtK ~
, . . ;,l.,f ~ , LE
r . ; : Rq~~it s~ ~~JNTY
, . ' -,:`'r;'" ^.JT, LUC1E CD ' '
- . ~ F~.C~~~A
.f r. , i
~
~ :,1 - , -
} • ~
t •,~J. ~\`ti.~.
~ . . . ,
~ •
I FURTHER CERTIFY that I will comp(y with all other requirements of a legal resident of this State.
t` I FURTHER CERTIFY ihat I have no intention to return to my former domi~ile, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~ . .
~ ~~a i.__ . ~ ti
. ~ -
~ ' ' (Name) ~
;'u~ i„•~ _
. _
. : y.
. • ,
. - .
- s.. . .
. . - . Josei IIrban
Ii . ~
.Y ',f
~ ~ (Address) ~
, i .:i::j:-~`'
~ ` 1 ~ a i.'' ~ ~
~ t'~+ .:c;~o-'{,'~/~C~'~~'~•. = ~ , c .
Svvorn to ~and subscribed before me this 12 day of _ Ja~~ , 19 ~
ROG~R POITRAS
CLERK CI IT CDURT Notary Public
~ty ~.C. My Commission expires
(To be executed in duplicate and original filed with Clerk Circuit Court, and duplicate with Tsx Assessor.)
BOOK _ .