HomeMy WebLinkAbout0141 Decla~ation ot Domicile and -Citi:~nship 15:~5~~
TQ THE STATE AND COUNTY TAX ASSESSOR,
Si. LUCIE ~OUNTY, FIORI~A: ~
This is my declarotion of Oomicile and Citizenship in ths State of Florids that 1 am filinq this day in aooo~danoe and
in conformity with ~hapt8r 224, Section 222.17, Florida Statutes.
I was formerly a legal resident•of ~lard Ohio
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and i resided at ~te ~ . However 1 have changsd my domkile
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ro and am a~d have been a bona fide resident of the State of Florida sinee 1~~ day of
December 9 6!t , and ~ roside at 180lt N. 4~h St.reet _
(Street and Number)
FORT MERCE, SJUNT LUCIEZOUNTY, RORIDA : ~
and this statement is to be taken as my declaration of citizenship, actval legal residenoe snd domiale in the State of Horida.
(Insert here any pcrtinent facts, such as sale of property or business, or relinquishment of emptoyment
at former domicile, removal of family to new domicile, purchase of home, etc.)
HQ!&STB~D PUI~OSE3
Sr, UC~N~p
E~~R~EO~
RECORD VERIFfE~•
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= ~ C~ERK ER ''O~tRAS
CIRCUIT ~pURT
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1 FURTHER CERTfFlf fhat 1 will oomply with all other requiremenn of a Is~al reaident of this Sfate.
I FURTHER CERTIFY that I have no intention to retum to my former domiCile, and I intend to remein in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. -
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, Ma~~ . s {
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180It l~. 49th Street, Fb. Pierce~ Fls.
(Address)
Sworn to and subscribed before me this 5~ day of J~~~ . 19 6? •
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Ro b..x.a,,.a ~ a~u~.~ s,~ . c~..+~ a~ c~.+, and dupticah with Tax ~a
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