HomeMy WebLinkAbout1050 1~~'_LE~E3
De~l~ratiorr of Domi~iie ~nd ~Gitiz~n~hip
TU TNE STATE AND COUNTY TAX ASSESSOR,
Sl. LvCIE COUN7Y, FLORIDA:
This is my declaration of Qomicile and Citizenship in ihe State of Florida that I am filing this day in accordance and
in conformiiy with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of __TrentOri _ _ N~W erSE
(C;ty) (State)
564 Howell Ave. 1'renton
and I resided at - . . Ho~vever I have changed my domiGile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since bth_ _ day of
Uecember 65 3726 St. ~rancis Rd.
- - - 19--- and I reside at -
(Street and Number)
FORT ~IERCE, SAINT LUCIE COUNfY, FLORIDA
and this statement :s to be taken as my declaration of citizenship, actual legal 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 fami~y to ne~v domicile, purchase of 'home, etc.)
Establishin~ residency ~
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I FURTHER CERTIFY that I wil) comply with all other requirements of a lega) resident of this State.
.,,1• FUR7H~j~ CERTIFY that I have no intention to return to my formzr domi~ile, and I intend to remain in FORT
' i ; : :
PIER~FV:~;~LM~1fi'~(I~IF.CUUNTY, FLORIDA, permanently.
_ ~y _~a'• ~.~'•_'~1•_ r _ . ~ _ ~ ~
- " y:. - . ' 1! _ 1~~Is~~+~?~~~__~c v' I
~`"1 ~'`!/fZ~r CLh ~
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- _ . (Name)
• - ' ~ Russell W, Bernhard
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- _ ' ~ . . , . , f~~C~l~ri(.uci r-~-Z/~ Q'"!'L
C
~ ' ~ Letitia Bernhard
Sworn to and subscribed before me ihis 20th _ day of - ~Tanaur~ , 19~~2.
;
ROGEtt POITRAS _
i RK CIRCUIT COURT Notary Public
By i~~~ D.C_ My Commission expires
(To be execuied in duplicate and original filed wilh Clerk Circuit Court, and duplicate with Tax Aszeswr.)
goox136 445