HomeMy WebLinkAbout0712 D~cla~ation ot Domi~il~ a~d Citis~nship 1~'3~ ~1
TO THE STATE AND COUNTY TAX ASSE'SSOR,
Sl. ltK1E COUNTY, FLORIDA:
This ia my daclaration of Oomicile a~ Citiunship in tlw Stat~ of Haida that I am filin~ thit day in aooorda~os ~nd
in conformify with ~haptsr Z22. Section 222.17, Florida Statut~.
.4~~z~ - .
t was formsrly a leqal resident of
(~ity) t~t.)
and 1 raided at o'~S ~ HowevK 1 hsve charpsc! my domWk
(Stnet and Number)
ro a~d am and have baen a bo~a fide rosident of the State of Florida iinoe - day of
, 19 , and 1 ~eside at ~ y~ ~/~~~(6~
(Street and Number)
PORT M~C~, SAMIT ~tlCIE COUNTY, RORIDA
and this statement is to be taken as my dedaration of citi~enship, actvai legal residenoe and domicile in fhe Staro of Fb~ids:
pnsert here any pe?ti~ent facts, auch as sale of property or business, or relinquishment of employmsnt
at forme~ domicile, ~moval of family to new domicile, purchase of t~orr~e, etc.)
~ ~~~~-a~h
~1L~~ AN~ REC4R~BD
COUNYY~
gT~ LUGrE yER1F1En '
~~:coRn
~ .
, 9 PM 12 : 4
69 JAN ~
;
i . pOt?R~S
~ ROG
CLERK CIRCUIT COURT
I FURTHER GHtTIFY that 1 will comply wiSfi all othsr roqulr~nenri of s leyal r~idsnt of this State.
I FURTHER CERTIFY that I have no intention to retum to my former domic,ile, an~ i intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanenfly.
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~ "~Wb[1~ ~vt~1d iUbiCfl~ ~fOfe ~T1e ~ili ~ day of ~9--L•
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By D.G. My Commiss'wn expires ~
(Ti b~ in d~ and e~ fiNd wilb C~Ic Ci~if Caref, and ~ wilb Tax Asw~xa
do K1?5 ~~E .71o i
- t~ 19
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