HomeMy WebLinkAbout1157 Declaration ot Domicile and Citizenship ~
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA:
This is my declarotion of Oomicile and Citizenship in the Siate of Florida that 1 am filing this day in accordance and
im m~formity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of ~y~ Y~ rlr _
(Ciry) (State)
and 1 resided at -_~'I-_G.; ~~'*~~PP°!' Street However I have changed my domicjle
(Street and Numbe~)
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to and am and have been a bona fide resident of the State of Florida since 1QL day of
,jul~_ , 19~8 , and f reside at Route 1 Box 51, Old Diuie HighwaY
(Street a~d Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in ihe State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, ett.) ,
~NG
~'r ~~D RECpR~JED 'i
. ' OUt,TY
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1 FURTHER CERTIFY that I witl oomply with atl other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no infention to retum to my former domiti~e, and I intend to remain in FORT
PIERCE, SAIN7 LUCIE COUNTY, FLORIDA, permanently.
A~r+~+.~/~ ~ ~ . .
(Name)
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Swqrr~~tst;~~fsubstcibed before me this a~at day of T~uary , 19~_.
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~~~~~e~~~ Notary Public >
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gy - ' O.C. My Commission expires
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Ro 6r~~q1hr1'in dupliut~ and original filsd with CtKlc Cirwit Court, and duplicab wifh Tax Assat~.)
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