HomeMy WebLinkAbout0077 ~ D~aluatiO~t Ot OOmicilo a~d C1tIzN~ship - j~
TO !HE STATE AND COUNTY TAX ASSESSOR. ~ a
51. lUC1E COUNTY, FLORIOA: ~
This is my declaration of Oomicil~ and Citizenship in th~ State of Horida th~t 1 am filiny this day in aooorda~a and
in aonformlty with Chapter 222. Section 222.17. Florida Statut~s. ,
1 was formsrlv a leqal resid~nt of ~a• J. .
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59 Lbntral At?e. How~vK 1 haw cha~p~d my domidl~
and 1 resided at
(StrNt ~nd Number)
ro and am snd have been s bona flde r~ident of th~ Staf~ of Florid~ :inoe ~ ~Y ~
Januar~ - , ~ 9 67 , and I nsid~ at ` 1701 Hiapat~a ~r?s, -
(Sttut a~sJ NumbK)
FORT MQC~, SAINT LtlCif COUNTY. RORiDA -
and this :tatement is ro be taken a: my dsciaration of atin~nship, actual lepal raidenos and domkile in fhe Sht~ of Horida.
(in:ert h~m any pertjnent fact:, :uch st sslQ of property or busines:, or relinquishmsnt of employnwnt
at fomr?er domiale, ronwval of family to nsw domicile, purchase of homs, Mc.)
FTLII~ FOx H(1i83Tl~AD PO~S
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C~-ER
1 RJRTHER GHtTIFY that I will aorr~ply with all otl~er nquir~MS of a le~l resident of thb State.
I FURTHER CEitTIFY that 1 have no iMention to retum to my former domicjle, and 1 intend to remairr in FORT ~
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PIERCE, SAINT LUCIE ~OUNTY, FLORIDA, permanently. ~
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`~s~~•'f~. ~ibsd befo~ me this day of Xn6ue~ , 19~._.
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gy D~C. My Commission expins
Qi b~ d~ aad ai~i~sl t~d wNb CI«k Ci~w~if C~ret, d~h wNl~ ?ac As~~J
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