HomeMy WebLinkAbout1038 Deciaration ot Domicit~ and Citis~nship
166~51
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUGiE ~OUNTY, FLORIDA:
This is my decla~ation of Domicile and Citizenship in the State of Florida that 1 am filing this day in t+ooordanos and
in oonformity with Chapter 222, Section 222.17, Flo?ida Statutes.
.
1 was formerly a legal resident of ~ ' -
(Ciy) t5ta»)
a I r i at T" " . However 1 have cha~qed my domitile
nd es ded
(Street and Numbe~) ~
~ to and am and have been a bo~a fide residant of the State of Florida sinte G day of
- - 19~" , and I reside at ~ ~ ~
~ (Street snd Numbe~)
fORT PIERCE, SAINT LUCIE COUNTY, ltORIDA
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 pe~tinent facts, such as sale of property or business, or reli~quishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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~ CLE~RK CI'ReU1T COURT
~ 1 RlRTHER CERTIFY that 1 will oomply wlth al) othsr requi~eme~is of a le~a! resident of thi: State.
I FURTHER CERTIFY that I have no intention to retum to my former domiCile, and 1 intend to remain in FORT
PIERCE, SA1NT Lf~1C1E COUNTY, FLORIDA, permanently.
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, to ar+d wbsuibed before me this /D day of ~ ~9 `i0
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~ Notary Publk
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gy ~.C. My Commissfon .xpins
(Ti w~aaN~i lw d~lisaM Mi~lw~l AM~ i~~~~ a~ ~ wMl~ Ta~c A~ra
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