HomeMy WebLinkAbout2435 Declaration ot Domicile and Citize~shtp
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, F~oa~uA: 18513~
This is my declaration of Domicile and Citi:enship in the State of Fiorida that 1 am fiiin~ this day in aooo~danos and
in conformity with Chapter 222, Section 2?2.17, Florida Ststutes.
1 was formerly a legal resident of , .
(Ci a~)
and 1 residad at U ~ . However 1 have cha~qed my clomidle
- (Street and Number)
ro and am and have been a bor~a fide resident of the State of Florida since day of
, 19 , and 1 reside at ~ ~ ~ ~ ~e~-~'~~~ •
(St~eet snd Numbe~)
FORT PIptCE, SAI LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaratian of citizenship, actual legaf residerKe and domiuie in the State of Horlda.
(Insert he~e any pertinent facts, such as sale of property or buaineu, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
. .
FILEO AND RECORQED
ST. LUCIE COUNTY. FLA.
c?= CORC~ V~ RIFEED
. 18513f3
'69 f~UV 4 PM 2: IO
'
j i:OG~r~. r°OITR~S
~ CLERK CtRCUIT COURT;
E
1 FURTHER CERTIFY that I will oomply with all other requiremsnt~ ot a lepal resident of thts State.
I FURTHER CERTIFY that 1 have no intention to retum to my former domiale, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~ ~
(Name) ~,,~~d'~,y~,~~- ~
~~:~ttt~~t:l~~~., i ` . p2~ ~s ~ w! •
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~~i~, f@SS
e`, ~i~...•`•! ia"i -
, -
1' Sw~n to anti ~su~ed before me this ~ day of 19 .
_
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: - - ~ : ~ : .
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=.,i ~zV..~' _
~~~~J•~~
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d~ERK'CII~ 11~COURT Notary Public
.
By D.C. My Gommission expires
(To b~ ~x~cut~d in duplical~ and ori~inal Al~d whb Cl~elc Grarit Coue~, and d~icah wilb Tax AsM~xa
a~~~0 ~2432
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