HomeMy WebLinkAbout0124 Declaration ot Domic~l8 ans! Citizenship ~
TO THE STATE AND COUNTY TAX ASSESSOR,
51. lUC1E COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
in conformiy with Chapter 222, Sectio~ 222.17, Florida Statutes.
I was formerly a legal resident of - • - -
;ty~ ~ tate)
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and 1 resided at _ _ _ u ~ ~ _ _ _ . However 1 have changed my domiG~e
( eet and Number)
to and am and have been a bona fide resident of the State of Florida since ~.T__-__~ day of
, 19Q , and I reside at 1 V L'
- ree an um r
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
(Insert here any pertinent facts, such as sale of properry or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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FILEO AP~tD RECORDED
S~. LUCI~ COUh'TY, FLA.
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~ '10 J~#~ 5 Aht II: 03 ~
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C~~RK CIRC~~tT COURT
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I FURTHER CERTIFl( that I will comply with all other requirements of a legal resident of this State.
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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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~ _ Sworn to and subscribed before me this day of , 19
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~ ~ ROGER PQIYRAS f
~ K CIR~UIT COURT Notary Public
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~ gy ~ D.C. My Commission expires
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_ (To be executed in dupliute and ori~ioal filsd with Clevk Grcuit Courf, and duplicate with Tax Ass~or.)
~ EooK 1$2 encE 1z4
tix ?Jo. 13
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