HomeMy WebLinkAbout0465 Declaratton ot Domlcil~ and Clt~~nship ~~3490
TO THE STATE AND COUNTY TAX ASSESSOR,
Si. LUCIf COUNTY, RORIDA:
This is my declaration of Domial• a~d Citiunship in th~ Stat~ of Horkla that I am filinq this day i~ aooorda~at and
in conformity with Chapter ~22, Settion 222.17, Florida Ststuhs.
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• i~Cr-Gri .
1 was formsrly a Ipal ros'~nt of
fy~ (St~t•)
and 1 rosid~d ar `20 ~ ~r~~a~ However 1 haw durp~d my domjdl~
(She~t and NumbK)
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ro and am and have been a bo~a fide ~es'ident of the Sbts of Florida sinos ~Y ~
, 19 ~a , arx! I roside at
~ and Numbsr)
PORT ~ SAINT LUCiE COUNTY. RORIDl1
and this ststeme~t is to bs taken as my dsdsration of dtiunahip, actuai Is~si residenoe and domkils in the Stab of Horids.
pnsert here any pertinent fscts, such as sale of propsrty or business, or rolinquishm~+t of employn~nt
at former domicile, rarrwval of family to new domicile, purd~ase of han~, etc.)
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FIl,EO AND RECOROEO
~ ST. LUCIE COUNTY. FIA.
• REC RD VERIFIED/
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'69 JAN 1,~,3~~~ ' I 6
~ Ro~eR ~oirn,~s
CLERK CIRCUIT COURT
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1 FURTHER G~RTIFY that I wif}?aompfy with all otF~ nquirur~b of a le~al nsident of this Sta1e.
i fURTHER CHtT1FY that 1 have rw intention to retum to my former domitile, and 1 intend to remain in fORT
PIERCE, SAINT: LUC~E COUNTY, FLORI~A, permanently.
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--~'i~vom..fq,.,nil' iubsuitisd bef«e rrk+ thi: ~ dsy of 1
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ClRGlIT Notary Pubik
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By D.C. My Commission expires
R~ b~ ~a~d M drplkw ~d ~ioiw~l Rl~d wiN~ CMelc Ci~it Cew~, and dupiial~ witM Tax Awa~J
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