HomeMy WebLinkAbout0560 D~cla~~tion ot Domi~ll~ ansl Citis~nship js~~~
TO THE STATE AND ~OUNTY TAX ASS~SSOR,
51. lUC1E COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenahip in the State of Florida that I am filinq thit dsy in aooordanos and
in conformity with Chactar 222, Section 222.17, Floridd Statutas.
I was formerly a legal ~esident of L~•i ttowri P~~II~~'148~ia
~Ciy~ (Statr)
and 1 resicisd at 1+ Besid . However 1 have chan~sd my domidle
(Street and Number)
ro and em and hsve been a bona fide resident of the Stata of Florida :inos Z~ d~Y ~
.U 1~. , 19~, a~d 1 mside a~ 5201 $outh Ind~~ gi~er Drivo_
(Stroet and Numbsr)
Port Pi~rc~, tlorida
FORT rI~CE, SAINT LUCIE COUNTY, RORiOA ~
and this statement is to be taken as my declaration of citi=enship, actual laqal residenoe and domidle in fhe State of Horida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at forme~ domicile, removal of family to new domicile, purchsss of home, etc.)
E~teblioh 8~sidency ~
i ~
No R~co~o~~' -
F~~uC;E ~~V~+E~ ~
: ST•RL~ORp VE vm, '
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' C1-ER
1 RJRTHER CERTIFY that i will oompiy wifh aii other rsquirements of a le~al rosidsnt of fhis Stste. ;
1 FURTHER CERTIFY that I have no intention to ret m to my~form r icjle, and I intend to remain in FORT
PIERCE, snipT'-:l~~ couNnr, FLORIDA, permanently.
~ ~ _:~~`~f;
f``i . ~r; .
' . ; : ~ _
_ ' • ~^J•:' ~ • ' Henri~tta Dlowell
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6
Swoth fo and subsaribsd before me this 13 th day of Ju1T , 19 T
ROG~ 'OITRAS
CL[~IC CIRCtliT C Notsry Public
gy ~.C. My Commiuion expires
(Te b~ ~aM~d in dupNcab and ori~inal Hl~d wilb Ci~elc CinaiN Covet, and dvplkaN wHit Tax A~~orJ
iOD~f ~~7 MCE ,
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