HomeMy WebLinkAbout1016 Decla~atlon ot Domicil• and Citi:enship
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TO THE STATE AND COUNTY TAX ASSESSOR,
Si . lUC1E GOUNTY, FIORIDA: ~
This is my declaration of Domicils and Citizenship in tha State of Florids that 1 am fjlirp this dsy in aaordanos and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
I was forme~ty a lagal rssident of
(CitY) (Stet+)
and I resided at ~ . Howevsr 1 hava chanQsd my domidte
(Street and Numbe~)
to and am and have been a bons fide resident of the St~b of florida since 26~ day of
Nove~nber ,~q 65 , and I ~e:ide a~ 807 (3ardenia ~ve.
(Street snd Number)
FORT PlERCE, SAINT LUClE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the Staro of Horida.
(Insert here any pertine~t facts, such as sale of propsrty or buslneu, w relinquishment of employment
at former domiciie, romoval of family to new domicile, purchase of home, ett.)
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FTLING FOR HOI~T~STFAD P'URPOSSS
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ST~REC a~ V~RtF1EC
1~2~-'~ : 21 ~ -
*61 JAN 25 PM 2
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RKJCIRCUIt C011R?
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€ 1 FURTHER ~ERTIFY that 1 will oompty with aii other requirements of s Ispal rasiclent of this Stats.
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~ I fURTHER CERTIFY that I have na intention to retum to my former domi~ile, and 1 intend to remain in FORT
! PIERCE, SAINT LUCIE COUN7Y, FLORIDA, permanently.
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\T C p~~i;~- WII.LIAH G. SPI Q~T~
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: ' Swqi~,~pr ~ aybsuibed before me this da of , 19
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` CIERK C OURT Notary Public
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€ aY D.C. My Commission expires
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(To b~ ~acvt~d n duplical~ and ori~ins! Rl~d witb CINk qrarit Covrt, and d~plicat~ wi11~ Tan A~or.)
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