HomeMy WebLinkAbout2104 Oeclar~tion of Do~nicil~ and Citlz~nship 1s~8£~6
TO THE STATE AN~ COt1NTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FlOR10A:
TF,s is my declaration of Domicile and ~itizenship in the State of Florida that I am filing this day in aocordance and
conforrciiy with Chapter 222, Section 222.17, Florida Statutes. ~
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1 was formerly s legal ~esident of ____Qt~Q3L _ _~.~.IIi~___
(City) (Staro)
and 1 ~esided at 2523 3rd StZeet SOUth However 1 have changecl my domitila
(Street and Number)
ro anci am and have been a bona fide resident of the State of Florida since ._____8t2L_____ _ day of
December 19 67 , a~d ~ res;de ar ~494_QY~rbrook Drive
~ - - (Sireet and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement ;s to be taken as my declaration of citizenship, actual legal residence and domicile i~ the State of Ho~ida.
(Insert here any pertinent facts, such as sale of property or business, or ~elinquishment of employment
at former domicile, ~emoval of famity to new dom~cile, purchase of home, etc.)
$5tablish residency for homestead purposes
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, N~ R~COR~~ A -
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I FURTHER CERTIFY that I will oomply with all other requirements of a leyal resident cf this State. ~
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1 FURTHER CER7IFY that I have ~o intention to return to my former domic,ile, a~d 1 intend to remain in FORT ~
PIERCE, SAINT LUCIE COUNTY, FIORfDA, permanently. ~
• - CL-ia-r~
(Name) Zula H, Man~1
(Address)
.•Swocn to and suburibed befo~e me this ~ day of Decenber ~ ~q 6?
• . " ~ ' Rt~}ER~:~41TRA5 _ ~
CL~K tIRGU1T COURT Notary Publit f
gY ~ D.C. My Commiuion txpires ~
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(To b~ ucecuhd in dupliwb and ori~inal 51ed wiNi Cla~ic Cirwit Cour~, and duplicat~ with Tax Ass~stor.) t
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