HomeMy WebLinkAbout1271 ,
Declaratio~ ot Domicile and Citizenship
~45t~3 .
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. tUC1E GOUNTY, FLORIDA:
This is my declarotion of Domicile and Citizenship in ths State of Florida that I am filing this day in aooo~danoe and
in oonformity with Chapter 222, Section 22~2.17, Florida Statutes.
I was formerly a legel resident of 6~~~'~Y~I~'+~L.~ , C
(City) ~ (~a~)
and I ~esided at y0~ ~ o~~v/'Fw T~~~~~ _ . However 1 have changsd my domic3le
• (Streat and Number) ~
ro and am and have been a bo~a fide resident of the State of Florida since 1~ ~ day of
~C OT / y, ~c ec, f-~ a o y
~ -~'1/92G°H ,~9~, and ~ ~eside at ~0 6.~N ~0.~'iUr~y f~S7~ ~vc~ ~
, (Sheet snd Number)
FORT'IHtCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my decla~ation of citizenship, actual legal residence and domicile in the State of Horida.
(Inseh here any pertine~t fads, such as sale of propiarty or busineu, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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~ 66 MAi 9 AN 36 ~
45iCi93
R~QER ~OrTR~S. CLERK ~ ~
ST. LUCIE COUNTY.
FL~R10A N .
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1 FURTHER CERTIFY that 1 will oomply with all other requirements of a lepal resident of this State.
I FURTHER CERTIFY that 1 have no intention b retum to my former domicjle, and 1 intend to remain in fORT,
PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently.
Q~
wi~~~
(PJame) C~e~~.
~d~ 30~Sf N d~ zzid~
(Addres:)
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Sworn to and subscribed before me this - day of , 19~~
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RJ~1 L.lL
CLFRK CIRCUIT COURT e~~, ~ V~i'%``'~.;,- Notary Public
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By : ~nmission expires
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(To b~ ~auaM~d M duplicaN aed ori~in~l " , and d~plk~N wilh Tax As~o~
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