HomeMy WebLinkAbout0085 F.
1~4~3 o~alar~t~o~ ot Daniai~• and Citis~nship .
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FIORIDA:
This i: my decla~ation of Domicile and Citizsnship in th~ State of Florida thst 1 am filin~ thi: day in sooo~danos ar~d
i~ conformity with Chapter 224, Saction 222.17, Floride Statutet. .
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1 was formerly a tegal rosident of
(City) (Statr)
/
and 1 resided at _ ~ . However I have chanqed my domidle ,
- _ (Stroet and Number)
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to and am and have been a bona fide ~eaident of the State of Fiorida sinoe ~ d ~dsy of.
~ , 19ZQ, and 1 roside at ~ , ~ .
(Street. and Number)
FORT HERZE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaraY~ of citizenship, actual legal residenoe and domicile in fhe State of Horida.
(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, etc.)
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FItED AND RECOROED_ ~
' S'. IUCtE COUNTY. F~A.
F~C.CC`Rt VE~l~!F~ ~964~a~
` ~ '70 JU~. 27 AM II:04
~ -
~ ~~C=Fr~. ~OtTRAS
~ Cl.~RK CiRCU1T COURT
1 RJRTHER CERTIFY that 1 wil) comply with all other requirements of a lepal resident of this State.
I FURTHER CERTIFY that I. hava no intention to ~retum to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~~rS, /~0~~4~ C. '8v~~~'f~e^~ <~~~e~
- ~
(Name) -
(Address)
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Sworn to and subscribed before me this ~7 day of . 19.~1Z-
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• ~~1~~~'~ ~ Notary Public
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By ' ~ D.C. My Commission expires
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= - ' 3 - ;
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r and ori~inal fil~d wiTh Ci~elc Grwk Couif, and duplkst~ wilh Tax A~or.)
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''~.,.1 n '~S~ • ~ '80~1(~~~ ~ -.'~T~
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No. 13 ~ _
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