HomeMy WebLinkAbout2906 Deciaratio~ ot Domicile and Citizenship ~-6~~~
TO THE STATE AND COUNTY TAX ASSESSOR,
ST. tUC1E COUNTY, FLORIDA: ~
This is my declaration of Domicile and Citizen:hip in the State of florida that 1 am filing this day in aooo~dance and
in tonformity with Chapter 22Z, Section 222.17, Flo~ida Statutes.
1 was fo~merly a legal rasident of ~~~as
(City) (State)
and 1 reaided at __~Q ~ . However 1 have char~yed my domitile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since - day of
DN~ 19
6~, and I reside at 'Z~~ ~tib ~i
- - (Street and Number)
FQRT ~I~tCE, SI?INT tUC1E COUNTY. RORIDA
anci thts statement is to be taken as my declaration of citizenship, actual lega) residenca and domicile in the State of Horida.
-(Inssrt here any pertinent facts, such as safe of property or business, or ~elinquishment of employment
at forme~ domicile, removal of family to new domicile, purchase of home, ett.)
~S?ABLISB BR'il~i
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~t~EO AND RECQRD~D
ST. LUCIE CQUNTY, ~Lt.. ~
r ~ ?"~~pf"l~~~~~rp ~
16`7359
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f,~ ~ i '68 F~.AY 23 8: I 9
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, Y tt;O:;EP. i•01'~R~S
~ ~i e CLERK CIRCUIT COURT
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I RlRTHER CERTIFY that I will compty with all other requirementt of a leyal resident of this State.
I FURTHER CERTIFlf that 1 have no intention to return to my former domitjle, and I intend to remain in FORT
~ PiERCE, SAiNT IUCIE COUNTY, FIORIDA, permanenNy.
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(Ad~ress)
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~ Sworn b snd subx~ibed before ms this day ofv~~ ' , . 19 e
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