HomeMy WebLinkAbout0471 D~cl~ration ot Dornlcil~ a~d Citis~nship 1~~~~
TO THE STATE AND COUNTY TAX ASS[SSOR,
Si. UJCIE COUNTY, FIORIDA:
This is my dsclantio~ of Domicile and Citizen~ip in ths Stats of Horlda that I am fllin9 thi~ day in aaoo?dar~ ~nd
in aonformify with Chaptet 222, Sectio~ 222.17, Floride Statutes.
1 was formerly ~ leqsl roskJ~nt of '
(C tSfa~)
and 1~ided st Fbwwer 1 havt chanp~d my domkil~
(Strett a~x! Number) '
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ro and am and have baen a bona fid~ rosident of the State of Florida sinoe day ~
~~~n.~'.~.~/ /o o.~ ~ C~~-
, 19 , arxJ I reside at ~
(Streff and Numbsr)
~O~T N~. tAINT L1ldE COUNiY, RORIDA
and this atatement is b be taken as my dedsration of atizenship, actual le~al residenoe and domicile in the Stst~e of Horida.
pnsert hers any pertinent facts, such as ssle of propsrty or business, or ~elinqui~ment of employmsnt
at fo:mer domidle, mmoval of family to ~sw domidle, purchase of tarne, etc.)
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~ ~LEO ANQ RECORDE~ -
:s'~. luci~ coUNT1r. FLA.
RE ORp VERIFIEO
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'69 ~AlY ~ AM 10: -
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ROGER~ P01~i~S
. CLERK CIRCUIT COURT:
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1 FURTHER CHtTIFY tfiat I will aompiy with all other roquinm~nt= of a lepal r~ident of th4 Shte.
1 FURTFIER CERTIFY thst 1 have no intention to return to m icjle, and i intend to remain in FORT
PIEitCE, SAINT LUCIE COUNTY, FLORIDA, permanentiy.
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-{•'~K;,fg,pncf~3ubscribed before me this day of , 19 .
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ROOER rOITRAS
C~WR Notary Public
ie.t.~t~ ~~~~1~
gy O.C. My Commiss'wn e~cpires
(Te b~ ~+~aNi in d~pNcah a~d e~i~in~l Al~d wMb CIKIc CiraiN Cov~, and ~ wilh Taoc As~ora
e~175 ~ 469
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