HomeMy WebLinkAbout0459 Decl~~ation ot ~om~cile and Citi:e~ship ,~51s02 _
TO THE STATE ANG COUNTY TAX ASSESSOR, ~
Sl. LlIC1E COUNTY, FLORIDA:
This is my decla~ation of Domicile and Citizenship in the State of Florida that r am filin~ this day in aooordar~os and
in oonformity with ~hapter 222, Section 222.17, Flo~ida Statutes.
1 wa: formerly a legal resident of ~mn (ieOl'gia
(City) (Stats)
and 1 resided at 307 Noorth lltth Street . Howevsr i have chan~ed my domkil~
(Street and Numbe~)
ro and am and have been a bona fide resident of the Stab of Florida sinoe l~ . c+sy of
~
A~at , 19 and I reside at Eerr Stl'eet at 4 Hou 6li0 ~
(Street and Number)
FORT N~C~, SAINT LtlCli COUNTY, RORIDA
and this statsme~t is ro be taken as my declaration of citizenship, actual legal residenoe and domicile in the Stats of Fiorlda.
(Insen here any pe~tine~t facts, wch as sale of properry or business, or relinquishment of employmant
at famer domicile, removal of femily to new domicile, purchASe of home, etc.)
Establishing reaidence
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~ 1 RIRTHER CHtTIFY that 1 will aomply with ail other requiroments of a lepal resfdent of thls Stste.
~ 1 FURTHER CERTIFY that i have no intention to retum to my former domiSile, and I intend to remain in FORT
PIERCE, S~AINT LUCIE COUNTY, FLORIDA, permanentiy.
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~ Swofn b and wbsaibed before me this 11~ day of J~~ , 19~Z.
~
~ ROGER POtTRAS
~ CIRCUR Notary Publk
B D.C. My~~"mmiss'wn expites
~
(Te b~ ac~aN~d in dupliesh and ori~ind Ai~d ClMlc C4a~it Coue~, and d~pliah wiN~ Tax As~er.)
a~K 164 ~ 457
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