HomeMy WebLinkAbout0295 , , . _
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' ~eclaration ot Domiaile and Citisenship - 12251'7
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' TO THE STATE AND QOUNTY TAX ASSESSOR, ' g
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~ ST. LlK1E COUNTY, FIORIDA: f£
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This is my dsclantion of Domicil~ snd Gitiunship in th~ St~t~ of Horida that 1 am filin~ this day In ~ooordano~ and
in aonformity wlth Chapter 2Z~. Ssttlon 222.17, Florida Statutes.
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1 was formerly a le~d ~esident of -
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and 1 residsd at 8 YoDougal O~t~l'~ _ HorwvK 1 have chsn~sd my domWl~ ~
(Street a~d Numbsr) ~
fo ~nd am and have been a bona fids resident of ths Stet~ of Fiorida sinoe day ~ *
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~ ~~k , 19 and I rosids ~t 985 A11'Ot~ Bl~d• Po]c'C Ss.Llloie
(Sheet and Number)
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RORT M~CE, SAINT LUCIE COUNTY, RORIDA ' `
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. and thl: statement is to bs tsken as my dedsration of dtizenship, actual le~al residenos and domklle in ths State of Fbrida. -
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pnsart hero any pertinent facts, such as ~la of propeny or buiiness, or ~slinquld?m~nt of empioym~~t
at form~r domicile, rerrwval of family b new domicile, purchase of Fwme, Mc.)
12251'~' -
Establiahing resideno~ and ~ppl~ing !or ho~e~te~d
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800K
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~ ~~~Er`~~.•..?~•~~~o~~ 1964 k..i
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I FURTHER CERTIFY that 1 will rspi:ter at my loat sddrest whsn ths tpistr~tion bookt reopen, and oomply with
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-!I other roquirements of a le~al resident of this St~ts. >
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I FURTHER CERTIFY that 1 have no intention to r~tum to nny former domidie, and F intend to ramain in FORT ~~y
~ PIERC'E, SAINT LUCIE COUNTY, FLORIDA, perma~tly.
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