HomeMy WebLinkAbout0269 D~claration ot Domicile a~d Citizanship ~
TO THE STATE AND COUNTY TAX ASSESSOR, ~4~~
51. lUC1E COUNTY, FLORIDA:
Thia is my daclaration of Domicile and Ctizenship i~ the State of Florida that 1 am fili~g thi: day in acoo~darw~ a~d
in oonformiy with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of ASh18Dd KCntuCky
(Ciy) (State)
and 1 resided at 2204 HOt~ Street ~~,,,ever 1 have chsnged my domic3le
(Street and Number)
ro and am and have baen a bona fide resident of the State of Florida since - 16th day of
, ~u ¢u s t 19~.~L_, and I reside at ~ A~ 4 Ave C -
(Sireet and Number)
FORT M~CE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
pnsert here any pertinent facts, such as sale of property or busineu, or ~elinquishmant of employment
at former domicile, removal of family to new domicile, pu~chase of home, etc.)
Bntering Jeff in school _ ~
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I FURTHER CERTIFY that I will comply with all other requiremenis of a(e~al resideM of this State.
1 FURTHER CERTIFY that I have no intention to retum to my former domicale, and I intend to remain in FORT
PIERCE, SAt~~ ~#C~E COUNTY, FLORIDA, permanently.
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~ 23rd August 66
Sworn to and suburibed before me this day of , 19 .
ROGER ~ORRA~
CIRCU COURT Notary Public
B D.C. My Commission exp~res
(Ta b~ uaevf~d in duplicab and ori~inal Bled wiTh Cl~lc Cira~it Coue~, and duplieat~ with Tax A~er.)
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