HomeMy WebLinkAbout0189 t~eciaration of 13omiCiie and ~itizenship ~
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TO THE STATE AND COUN i Y TAX AS~ESSOR, .
Sl. IUCIE COUN7Y, FLORIDA: ~
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11115 IS my deciaraiion oi UO(711C11~ dllti ~.IIILCI13111~1 li'i iili: JIOIC iii i iviiild iiioi i ac~~ ~~ccc~y czcs3 :%:.y -
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in conformity wifh Chapier 222, Secfion 222.17, Florida Stafutes. ~
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I~vas forrr,erly a legal resident of Alexandr_ia_ Virginia
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(Cit ) (State)
1418 Mt Ve rnon Ave, However 1 have chan ed m domi~ile ~
and I resided at - . - . ~ y :
' (Street and Number) '
to and am and have been a bona fide resident of the State of Florida ~ince 29 day of
April 64 ~OOS Poinset~ia Drive
- . 19----, and I reside at _ _
(S~treet and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizensh~p, artual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at formzr domicile, removal of family to new domicile, purchase of home, etc.)
FllED AND l~~~ED -
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~ss ~a~ ~s a~ y~ s
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Establishing residence ~-'f
ROGER P01-i RAS. CL.ERK ~
ST. LUCIE COUNTY, ~
F~ORlDA =
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I FURTHER CERTIFY that I will comply with all other requirements af a legal resident Cf'this-;Stat~2::. ~ r, ° '
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I FURTHER CERTIFY fhat I have no intention to return to my former domiCile, and I intend to remain in FORT F
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PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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; ; ~ ~ . ~ (Name) ~
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~ . ' - ,john a, Neal, Jr ~ s
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~ ` 28 January 66 ¢
~'r~S'YvcS~n.to •and subscribed before me this _ day of - _ , 19 • A
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ROCER POlTRAS ~
LERK CIRCU COURi Notary Public ~
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gy D.C. My Commission expires ~
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~ (To be executed in duplicate and original #iled with Clerk Circuit Caurt, and duplicate wit#~ Tax Assessor.) ~
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