HomeMy WebLinkAbout1475 - - - _ . ~
D~claration o! ~~mi~ii~ anc9 Citigenship
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TU THE STATE AND COUNTY TAX ASSESSOR, ~
Sl. IUCIE COUNTY, FIORfDA~ ~~Ra~~
This is my declaratiori of Domicile and Citizenship in the State af Florida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was form~rly a legal resident of wa)'n e S V i l~e (7t11 O
(City) ` (State) - ~
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and I resided at Bp33 _1$Z . However t have changed my damiGile r
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to and am and have been a bona fide resident of the State of Florida since _?6th day of ~
Jana~iry 66 340 shle St ' ' ~
19,----, and 1 reside at A-------Y Wh1te C1t}~ `
(Street and Number)
FORT RIERCE, SAlNT LUCIE COUNTY, FLORIDA ~
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and this statement is to be taken as my declaration of citizensl~ip, actual legal residence and domicile in the State of Florida. r
(Insert here any pertinent facts, such as safe of prope~ty or business, or relinquishment of employment
at former domicile, removal o'f family to new domicile, purchase of home, etc.)
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Entering children in school
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' R~G~h t='~~ ~ Ct_ERK ~
. ` ST, LUCIE COUNTY. ~
FLORIDA ,
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I FURTHER CER7IFY that I will comply with all other requirements of a legal resident of this 5tate.
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I FURTHER -CERTIFY that I have no inlention to return to my former domi~ile, and I intend t~ remain in FORT f
PIERCE, SAINT LUClE COUNTY, FLORIDA, permanently.
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• ~ • ' (Name)
, ` R Lee ~ullivan
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, S.,vnm tn anr~ subscribed before me tF?is - 31 day of -.__~anau V ~ 19~_,
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RAGER POITRAS
C RK CIRCUIT COURT Notary Public
8 D.C. My Commission expires I
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(To be executed in d~plicate and original filed with Clerk ~ircuit Court, and duplicate with Tax Assessor.)
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