HomeMy WebLinkAbout1496 Deciaration ot Don~icfie a~d Citisenship ~~?2;~gg
TO THE STATE AND COUNTY TAX ASSESSOR,
5~. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing thia day in aaordanos and
in conformity with Chapter 222, Section 222.17, Fiorida Statutes.
1 was formerly a legal resident of ~i~TiCD f?~
(~iy) (Staro)
.
and 1 msided ah~~Q~ ~~7~~AT/GD~-~ . However I hsve chanyed my domiG~e
f (Strost and Number)
to and am and have been a bona fide resident of ihe State of Flwida since day of
,~G~ , 19~ and 1 reside at~
,'~~~TQ d'l~~/y~
~~~~-1~~~ •
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNT1f, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horlda.
(Insert here any pe~tinent facts, such as sale of property w business, or relinquishment of employment
at former domicile, ~emoval of family to new domicile, purchase of home, etc.)
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I FURTHER GHtTIFY that I will oomply with all other requirsmenri of a Isyal resident of this State.
1 FURTHER CERTIFY that I have no intention to return to my former domic.ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~~l r` t ~ ~`~v FILED AND RECORD~D~ _ X (Name)
` "a = ST. WCIE COUNT'Y. ~L.A•
` r - ~ RECORn VERIf1ED ~
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~~''f.,SCv,JoTn' t~~~'~~ct+bal befo ~ip day of , 19 .
- CLERK CIRCUIT COURT~
ROGHt ~OITRAS
CIRCUIT~ RT Notary Pubiic
F
gy D.C. My Commission expires ~
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(To b~ ~oacuNd In dupliut~ and ori~tnal A{~d whh Cl~elc G~uit Co~r1, and duplluh wHh Tau As~or.)
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