HomeMy WebLinkAbout0912 ~
D~~claratic~r~ ot iDomi~il~ and Cit~z~riship
~ ()';'~i
10 TF~E STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUN7Y, FLORIDA:
I
Tl~is is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and ~
t
,
in conformity with Chapter 222, Secfion 222.17, Florida Statutes. ?
€
~
-
I was formerly a legal resident of C'a'~ Indiana
- - - - - - _ _ - -
(City) (State) ~
~
~
~
and I resided at l~~ 11 ;h Avenue However I have changed my domiCile +
- . _ - -
(Stre~t and Number) ~
10
to and am and have been a bona fide resident oF the State of Florida since _ day of
J~e 65 1012 N 22nd Street
- _ _ _ , 19--- - _ , and I reside at _
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual tegal residence and domicile in the State of Florida.
(Insert here any pertinent facts, sucl~ as sale of property or business, or relinquishment of employment
at forz~er domicile, removal ot family to r,ew domiciie, purchase oT nome, eic.)
I:ED ~ND RE~~RD o~K
~1
~r~ - ~{#I '-gY Recocc~
p~~ 3 : y2
Establishinb rasidenee ~6~ J~~~ ~ Z ,
~~'~t) rf~
~tK ~
,..•_'t 1=t.1~~`~~,.;~r.lT'l.
c~~~:j. ~v~,~ i,~~;-
. _ ~ • ~ A
, , ~LO
_ . ,
-
~ . `4 ' ~ .
' - . .<.ry• , ~ ~
~ - . ~ .r` •
Vi , • . . ' -
/ .
~ )•1 ~ • .
~
..•.1~~~ .
:'a'
I FUR7HER CERTIFY that I will comply with all other requirements of a legal resident of this State.
;
i
,
I FURTHER CERTIFY that ! have no intention to return to my former domi~ile, and I intend to remain in FOR7 ~
t
; PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
, ,
d
. €
_ _ ~~..e~ZZ.Q----- 1
. , . " (Name) ~
' i
~ - . :
: ~ Jeann~tte Sanders t
: ~
~ ' t. ' , . : ` (Address) ~
1 , • • .
~ . • . ' 9
~ ' ~
~ Sworn to and`subscribed before me this 17 day of - J~~ , 19 ~
~
~
ROGER POITttAS ~
CLERK CI CUIT COURT Notary Public ~
g. _ D.C. My Commission expires ~
y ~
~
? '
i (To be executed in duplicate and origina) filed with Clork Circuit Couri, and duplicaie with Tax Assessor.) ~
IZ ~ r~
I 80DK ~~b JO I '
~ < -