HomeMy WebLinkAbout1516 D~ta~ation ot Domlail~ and Citi~c~nship ~ -
TO THE STATE AND COUNTY TAX ASSESSOR, 15~~
Sl. IUCIE ~OIJNTY, FIORIDA:
This is my decla~ation of Domicile ~nd Citiz~nship in th~ Staro of Florida th~t i am fili~q thit day in aooo~d~~a a~d
in cor~formiry wifh Chspta 224, Settion 222.17, Florid~ Statut~s.
1 wai forme~ly a Ipal rasid~nt of ~~~nb~ ~~a='~~
~ . (City) (Sta~)
and I resiclsd at Cireddis RAad . How~ver 1 haw thanpse! my clOft~idl~
(Streef and Numbe~)
ro and am and have bean a bona fide ~id~nt of tl~e Stats of Horida sina ~h _ day af
Jn7v , 1~_, end I resids at 1~ ~le Aosd
~5trs~t and NumbK) .
FORT M~CE, SAINT LUCiE COUNtY, RORIDA -
and thk statemsnt is to be tak~n as my .dedaration of dtizenihip, ~ctual legef resid~noe end domkil~ in the Stah of FloNda.
(Insert here any pertinent facts, such as ssle of property or busjneu, or roft~quishm~nt of employm~nt
at former domidle, mmovsl of family to new domidie, purcha~ of har~, Mt.) ~ .
~tering abild in achool ~ ~a~i~ -
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1 RJRTHER CERTIFY M~t 1 wi0 aomply wHh ail ottNr rec~irerr~nb af a ip~l nssidemt of this Stat~.
1 FUR7`HER CERTIFY that 1 have no intention te rotum to my ~ormer domivle, and 1 intend to remain in FORI
PIERCE, SAINT WCIE COUWT1f, FlORIOA, permanentty.
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. Swiftn•to•etic~l wbsaibed before me thi: ~ day of J~' 19.~~7
ROOB l~ORRAi .
~ . Notary Public -
d~-•-~t~ C~
By D.C. My Com?niubn ~xpi~
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~(Te b~ ~oaerhd ~ dnpWcaa ~1 oe~al f~d wi~ Cl~elc CMaiM Cwe~, a~i drpNah wNl~ T~oc A~~a
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