HomeMy WebLinkAbout2547Jcclaration of Domicile and Citizenship ~ BARK 52 rt•6E 483
ST. ~ UC,E C:'I:N ~. FI A.
TO THE STe\TE AIv`D COUNTY TAX AS5E3SOR,
~T. LUCII: COliNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance
and in conformity with Chapter 222, Section 22217, Florida Stat,;tes.
I was formerly a legal :esident ot_ LL~iC~O
(City]
li°2 ~ou~;. isen~rd eve.
and I resided at - ------
[Street and Number]
to and am and have been a bona fide resident of the State of Florida since
ivvV c.~,~1C1
I i linoi~___ __
State
-_. However, I have changed my domicile
w8t11 _ day of
i Zr ~ c~~a•
19_= N and I reside at - ?'~ `~ ~l V" +
(Street and Number]
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA,
and this statement is to be-taken as my d~clarat:on of citizenship, actual Iel,~al residence an l domicile in the St:ae of Florida.
(Insert here at:y pertinc:u fart>. su°h as s~l~ of property or business, or relinquishment of employment
at former domi^ile, re;nocal of family to ne•,v domicile purchase of home, ete•]
E~1;_: D11S::11.,; i•esi~: er.cy
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FILED A~~DpR~E~C,,D~F~DED ~
~i~~ Q~~a~ 11~5..5tI-~-- ~DL(\
°S2 D`/~ 20 PM 12: 35
ROGEF PC~IT~ZAS, C~=~~~
ST. IUCIE CDU1.1 i'!, f LOftIDA
I, '''
~1
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I FL'I;TIIF.R CERTIFY that I will re,ister at my local address whe,~ the re~istratum b-o'cs reo?e:,, and comply
kith all other rrl::ire:nents of a legal resident of this State.
I F["I:TIII:I: CI:I;TIFY that I have n~ i~aentien to returr. to m}• former do^~icile, and I intend to remain in
FORT PIERCE, SAINT LUCIE COUiITY, FLORIL'A, permanently.
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HtI.~ ey ;;_. ..imp
(:'lddress]
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S~~orn to and subscribed t,etore, me this_ ~Rr~~,~'>'~ gay of _____ _ Lf:~-~-•_-~~1'-_---_-, 19-____~r::
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CLI:I;:i CI t' .:'iT CJ:.:'.T Y _, .. - _ Notar}~ Public
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3y- ----- --------------- '.-::r- ~•G. hiy Commission expires ------------
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- --- ------------ ~..1-~-+- .-- -------. _.----- -- - ------- --
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[To be executed in •Iuplicate and oriRin~l file3 with Clerk Circu[t Court, and duplicate with Tax Assessor)