HomeMy WebLinkAbout0044Declaration of ilomicile a*id Citizens}iip B~rK ~t3 F~GE ,'~~
TO 7HE STATE AND COUNTY TAX ASSESSOR, "~~~"~~~ _
3T. LUCIE COUNTY, FLORIDA: ~ -
This is my declaration of Domicile and Citizen: hip in the State of Florida that I am filing this day in accorc;ance
and in conformity with Ci.apter 222, Section 222.17, Florida Sta~~des.
8tep:ney Coin. _ _
I was formerly a legal resident of --- --•
(City) State
and I resided at t% r e 9C a tl t i~r i V @ _ __• Ho«•ever, I have changed n2y domicile
(Street and Nur-iberl -
L ~'ird _ day of
to and ari and have been a bona fide resident ~f the State of Florida ainct - -
Getclz?r _, is-s~ana I reside at _148 Bar,• arc Lrive
[Street and Number]
FORT PIERCir, SAINT LUCIE COUNTY, FLORIDA,
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State o[ Florida. -
[Insert here any pertinent facts, such as ssie of property or business or relinquishment of employment _
at former domicile, remo~•al of family to nea• domicile purchase of home, etc•1
~,stablishil~ residency
1~~9n1-
Ea
``~ ~~c-~
_ - ` - _ 1961 OCZ H CIE~RK
• Rp~ER POI~RASElOR10A '.~
= _ /~J. ~
I I'URTHElZ CERTIFY that I will register at my local address when the registration b_oks reopen, and comply
with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that i have t.o intention to return to my former domicile, and I intend to remain in
FORT PIERCE, Sf_INT LUCIE COUNTY, FLORIDA, permanently. / ~ ~
/J //~
[Name]
William M.'-'latson
[Address]
October _--. ly ~2_
Sworn to and subscribed before me thi= v~ ~tl any of -
• ~ . v• !,
R R PUITRAS -"" - -
~~ ~ ~{~ '~~~s Notary Fublic
,~~ CLERK .CUIT COURT ~_~at- n .,
~-~ -lti-~- C.~-~ _ D.C. ?y~~•,c;,amtlliSSion ~ ez*trrs- - -.-- -
3y~~- .. X _~ ~- ,
J ~- dupilcate with Taz dsseasor7
[To be executed to duplicate and origiasl filc3 ~sith Clerk C[reetti,,,t3gt~`t.~~