HomeMy WebLinkAbout1800Declaration of Domicile and Cltlzelnship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sj. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this dsy in aooordanoe and
in oonform~fy .v~th Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of ~ _
(Ciy) ate)
and 1 resided at _ ~ = ~ ~.._~~~,~ ~~~ However I have changed my domicile
(Street SfSc1 Number)
b and am and have been a bona fide resident of the State of Florida since ~~ day of
19~c, and I reside at
(Street and N mbar)
FORT PIERCE, SAINT LUCIE COUNTY, FlOR10A
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Fbrida.
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
~~
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1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
1 F ER CERTIFY that I have no intention to return to my former domicile, and 1 intend to remain in FORT
PIES~I UC~~OUNTY, FLORIDA, permanently.
~~W ~V
o ~,,. ~ r f- ~-
~ o> n.~ ~ ~ (Name)
n~o N a
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o~~ ~:- ~ 18242`7
o:
•,~ N ~~ v (Address)
_ •`~vra(t1'~b•jr>tlaubstribed before me this -~C_- day of _ , 19-~=y
~•
_ ;~•_ • ,;i'.OURT Notary Public
By y f ~, D.C. My Commission expires
y.,,y>t
(To be exeurted in duplicate snd original filed with Clark Cirwit Court, and duplicate with Tax Awaaaor.)
BOOK 179 1'A~E1, 798
No. 13
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