HomeMy WebLinkAbout0084 Declaration ot Domicile and Citisenship
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TO THE STATE AND COUNTY TAX ASSESSOR,
51. IUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship i~ the State of Florida that I a~~~ filing this day in actordante and
im m~formity with Chapter 22~, Section 222.17, Florida Statutes.
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1 was formerly a legat resident of _ ~~v - -
(City) (State)
and I resided at __~1 ~WeV~ ~ have changed my domicjle
(Sireet and Number)
to and am and have been a bona fide resident of the State of Florida since ~ day of
, 19~~, and I reside at , '
(Sir and Nu~ ~
~
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my decla~ation of citizenship, actual legal residence and domicile in the State of Horida.
(Insert here any pertinent fads, such as sale of property or business, or rel~r.~uishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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FILEO AND RECORDED~_ ,
S7. LUCIE COUNTY. FLA: ~
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R~_c~c~~ v~~~. 165450
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E '68 MAR 22 ~+I 10:31
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~ ~:o~t~< -~o~YRr,s
CLERK CIRCUIT COURT
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1 FURTHER CERTIFY that I will oomply with all other requirements of a IeQa) resident ot this State. i
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I FURTHER CERTIFY that I have no intention to retum to my former domitile, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, Qermanently.
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Name)~~~ ~u.GGu,~ • .e~rvrv
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~
~ (Address)
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~i~' ~"ar~J~subscribed before me this day of . 195e~--
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_ " .•C~C
C~RC~ 6Rt Notary Public
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gy ~ D.C. My Commission expires
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(To bi•~7(ACY}~ IQ dYj1j~C1f~ iflfl Of1~IMI ~I~ W~III CIKI[ C~KYI~ COYA~ and dupliah with Tax A~o?.)
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a~~.?1 ~ 84
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