HomeMy WebLinkAbout2130 De~claratifln ot Domi~ile and Citizenship
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TO THE STATE AND COUNTY TAX ASSESSOR,
S~. LUCIE COUNTY, FLORIDA:
This is rny dedaration of Dornicile and Citizenship in the State of Florida that I am filing this day in accordance and
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in conformity with Ci~apter 222, Section 222.17, Florida Statutes.
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I was formerly a lega~ resident of _~lbl@r _Laa__-___~_-___-_.__ _ :
.(City) (State)
245 Vallette
and I resided at _ _ . _ _ _ _ . . However I have changed my domiCile
(Street and N~mber)
. to and am and have been a bona fide resident of the State of Florida since 3rd day of ;
. FP-b - - , 19---66 and I reside at 1612 _U~~TI~,'~_~_v~-
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, ~LORIDA
and this statement is to be taken as my declaration of citizenship, actual 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
,;~~t!~l'.~f;'~dtm~r domicile, removal of family to new domicile, purchase of home, etcJ
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' : ~ E`n~'e ~in~; chi~dren in school
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6~E~ 14 PM 12: 3~ }
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S, CLERK ` `
~p?TR1~. ~
ROGER ~
g3. LUCIE COUNTY. ~
FLORtDA :
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I~ 1 FURTHER CERTIFY that I will comply with all other requirements of a legal residenfi of this State. ~
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I 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 LUCIE COUNTY, FLORIDA, permanently. ~
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~:,'.;i;.'.''L'1. ~ . t / '
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i '.~~-.~1~ : . , Name) <
- . . - Patrick ~enry ~,ickers Jr ;
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. , _ (Address) ~
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, 14th ~
~5wom ~to and subscribed before me this day of _ F_~b. , 19{2~-.
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RO ER POITRAS - ~
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CLERK CIRCUIT COURT Notary Public
By~~~' _~O~`'~~ D.C. My Commission expires
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: (To be executed in duplicate and original filed with Cierk Circuit Court, and duplicate with Tax As~essor.} ;
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. gooK 138 ~24