HomeMy WebLinkAbout2584 Declaration ot Domicile and Cltizensh3p 185~1
TO THE StATE AND ~OUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filirp this c3ay in aooordanos and
in co~formity with Chapte~ 222, Section 222.17, Fiorida Statutas.
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I was formerly a legal ~esident of 'e`'`~ ~
(City) tats)
and 1 resided at . However I have chsrped my domid~e
(Street and Number) ~
ro and am and have been a bona fide res'ide~it of the State ef Florida sinoe ~ day of
~1.~1 , 19 and t mside at
_ (Street a Nu ) -
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FORT MERC~, SAINT WClE COUNTY, RORIDA
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and this statement is.to be taken as my declaration of citizenship, actuat legal residenae and domiale in the State of Horida.
pnsert he~e a~y pertinent facts, such as sale of property or business, w relinquishme~t of empfoyment
at fomner domicile, removal of famity to new domiale, purchase of Iwrr~e, etc.)
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1LE~ AN~ oUNOYOF A.
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f 6P,2'16
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1 FURTHER GERTIFY that 1 wili oomply with all other requirements of s is~al roside~t of thb Stats.
I FURTHER CERTIFY that I have no intention to retum• to my former domivle, and I intcnd to remain in fORT ~
PIERCE, SAINT LUCIE COUNTY, FLORIDA,~ permanently.
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(Name) ~,`,Q,~yv ~
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(~lddress)
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~•~~o;~~d,subu~ibed before me this day of 19~
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' ~~~~iC ~~IRT Notary Public
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By " D
C. My Commiuion expires
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(To b~ ~xearhd in dupNcat~ snd oriyinal fil~d witl~ q
R Ciraiit Cou~, aed dupliaa witb Taoc I?r~ora
~~~.80 ~~i81
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