HomeMy WebLinkAbout2072 1`~'~U'~'15
D~ciuation ot Domiail~ and Citis~nship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY. RORIDA:
This ~ my~ decl~ration of Domicile and Citi~n~ip in ths Staro of flcrida fh~t 1~m filln~ thls day in aooordana~ and
in aoniormity with CMpt~r 22Z. Ssttion 222.17, Florida Statuhs. ,
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I wat formsrly a Ipal rosidsnt of .
Kib) h)
and I nsid~d at How~vK 1 haw tfi~rp«! my domWle ~
(Strost and NumbK) ~
to ~nd ~m a~d have baen a bona fids reiident of the State of Horida sinoe ~ d~Y ~
~1,~ . 19~ and 1 reside at l
G .
and Numbsr)
!'ORT ~C~, ~AINT L11ClE CONNTY, RORpA .
and this :tatbrr~t is to be taken as my dsciaration of citi~snship, actvai laqal residence and domicile in the State of fio~ida.
(InsKt here any pertinent facts, such as sale of properiy or business, or relinquishment of emp{oymsnt
at fam~ domicile, romoval of family to new domicile, purchase of home, etc.)
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I RJRTH~t GERTIFY that 1 will aompiy with all ather rpuirur~nh of a le~l resid~nt of th~ Stata.
1 RJRTHER CERTIFY that 1 have rw intention to rotum to my former cbmic,ile, and 1 intend to remain in FORT
PIERCE, SA1NT UJCIE COUNTY, FLORIDA, permanently.
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~ ~'fb:l~~b aub`uib~d b~for~ nk this ~ day of 19~.
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