HomeMy WebLinkAbout0792 ~~clara4ion ~t ~?omi~il~ and Citizen~t~~~ p ;
TO THE STATE AND COUNTY TAX ASSESSOR, ~[~:~C~(lCz
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51. LUCIE COUNTY, FlORiOA:
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This is m declaraiion of Domicile and Citizenshi f'
Y p in the State of Flarida that I am filing this day in accordance and ;
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in conformiiy with Chapter 222, Section 222.17, Florida Statutes. ~y
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Ozlando Florida ;
I was formerly a legal resident uf . - . -
(City) (State)
an~1 I raci~iP~ ~t 7~~ ~Xa11S Avenue . Howe~e~ ! have changed my domiGile '
(Street and Number)
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to and am and have been a bona fide resideM af the State of Florida since __14 day of i
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65 11U9 Rasedale Avenue ~
All~,tiSt-------, i9-------, and I reside at ~
(Street and Numbcr)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal res:dence and domicite 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.}
~t~~~~~.hlishing residence
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i FURTHER CERTIFY fihat I will comply with a(I other requirements of a legal resident of this State. ~
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1 FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT ~
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PIERCE, SAINT .LUCI~ COUNTY, FLORIDA, permane~tly. ~ i
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F . ~ , . . (Name) ~
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- ; ~~'i ~ ~ ' ~ Jef f rey I~. Thompson '
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14 January 66
Sworn to and subscribed before me this _ day of _ ,~q ,
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ROGER PO!'fRAS #
~CLERK CIR !T COURT Notary Public ~
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gY O.C. My Commission expires ~
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l (To be executed in duplicate and original filed with Clerk Cirsuit Court, snd duplicate with Tax Asseswr.) ~
BooK ~.36 1~7 ~