HomeMy WebLinkAbout0119 1 ~2~j
Declaration ot Domicile and Citize~ship
TO THE STATE AND COUNTY TAX ASSESSOR, ~
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Sl. lUC1E COUNTY, fLORIDA: , ~ f
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This is my dedaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and ~
in conformity with Chapte? 222, Section 222.17, Florida Statutes. ~
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1 was formerly a legal resident of -~r~-- - 'P~u~ -
(Ciy) te)
and I resi~~c~ at _ . However I have changed my domitile '
(Street and Number) i
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to and am and have been a bona fide resident of the State of Florida since _ day of ~
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1 and I reside at -
(St et and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FIORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Flo~ida.
(Inse~t here any pe~tinent facts, 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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F~ D AND RECORDED_
'T ~~~E COUNTY. FL~.
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I~ ~~~.~K CIRCUtT COURT
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I FURTHER CERTIFY that I will comply with all other requiremenh of a legal resident of this State. ?
I FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. °
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3 (Name) ~
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'.Syvor?t to and svbsGribed before me this ~ day of . 19 • _
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~ RoaiErt pazw~s ~
~ C{RC OURT Notary Public
~ gy D.C. My Commission expires
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~ (To be executed in dupliute snd original filed with Clerk Circuit Court, and duplicate with Tax Assestor.) '
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4 gooK 1~~ F~cE ~19
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