HomeMy WebLinkAbout0974 Decla~ation o! Domicile An Iti 1~4 f
d C senship 6
TO THE STATE AND COUNTY TAX ASSESSOR. ~
Si. LUCIE COUNTY, FLORIOA: ~
This is my declaration of Domicile and Citizenship in the State of Florida that I am filinq this dsy in sacordanoe and
in conformity with Chapte~ 222, Section 222.17, Florida Statutes.
DSIDS
N.Y.
1 was fo~merly a legal ~esident of
(Ciry) ~ ESt~»)
56-15 l~3~ X~e.
end I resided at ` . However I have chanyed my domic,~le
(Street and Number)
25tb
ro and am a~d have been a bona fide resident of the State of florida since ' day of
_ iij~ June , 19~ , and I reside at 7~ ~ndo Lane
_ . (Streat and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA .
and this statement is to be taken as my declaration of citizenship, attual legal re:idenoe and domitile in the State of Flo~ida.
(Insert here any pertinent fatts, such as sate of property or business, or relinquishment of employment '
at former domicile, removal of family to new domicile, purchase of home, etc.)
FII.It~G I~1UR HQiFSTFAD PURP~OSES ~
ST~UCIE~6t~p~
R£CORp VERIFIEO =
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CLERK C R U1~' C~ ~
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1 FURTHER CERTIFY that I will comply with all other requirements of a(e~al resident of this State. ~
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.I FURTHER CERTIFY that I have no intention to return.to my former domiGle, and 1 intend to remain in FORT ~
PI ~R~;.~ ?~r~JG~IE COUNTY, FlORlDA, permanently.
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Sworn to and subscribed before me this 2~~ day of JANUARI~ ~
ROGER PO
~ERK RCU OURT Notary Public
BY D.C. My Commiu'wn expires--
Ro b~ ~x~eut+d in duplicat~ anel oriyinal fil~d whh Cl~k Grcuh Cour1, and duplieN~ wHh Tax As~or.)
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