HomeMy WebLinkAbout0499 D~claration ot Domicll• and Citiz~nship ~~~~1
TO THE STATE AND COUNTY TAX ASSESSOR,
51, ltJCiE COUNTY. FIORIDA:
This es my declaration of Domicile and Citis~nihip in th~ State of Florida that I am filin~ this day in eoootdanos end
in conformity with Chapter 22~, Settion 222.17, Florida StatuMs.
I was formsrl a 1 1 rosid~nt of ~~i"_~~ •
Y ~
~ (City) (Statr) ~
and 1 rosided at 7~ ~iV ~ - How~ver 1 have dtarped my domWk
(StroM and NumbK)
ro a~d sm a have been a bona Nde msklent of the State of florida sinoe day of
, 19 ~d, and I reside at ~ 7~ G'~'P~-~
(Stra~t and Numbar)
I~ORT ~ SAINT LIlCIE COUNTY, RORIDA
and this statement is to be take~ as my dadaration of citi~snship, actual legal residenos snd domidle in the State of Horids.
qnsert here any pertineM facts, wch as sale of property or business, or mlinquishmsnt of employn~ent ~
at former domicile, removal of family to new domiale, purchase of home, stc.)
, ,
- RECOR~E~.
F11.E~ AN
~pUNTY. FI.A•
S.~.R~~o ~`E`~D
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; 6 PN 2 ~ ~9 ~
'69 ~AN ~ ~
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1 RJRTHER ~ERTIFY that 1 will aompiy with all other requirements of a lepal ~ident of this Stste. ~
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I FURTHER CERTIFY thst I have no intention to retum to my former domitile, and I intend to remain in FORT ~
~
PIERCE, SAINT WGE COUNTY, FLORIDA, permanently. ~
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" $aior~ ~Ird',ani! wbsuibed before me this ~ ~ ds , 19~ ~ . `
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Roa~ ror~~ws
CIRCUR `~Oti~T Notsry Public
f/
9y D.C. My Commission'expires
Re b~ ~aN~ ia drpNcsb aad ori~inal Hl~d wilh Ciwic CiraiM Car~f, a~d d~rplicaN wilh Tax As~eP.)
g~175 ~ ~~7
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