HomeMy WebLinkAbout2592 ~
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D~cla~ation ot Oomlail• and Citis~nshlp ~
TO THE STATE AND ~OUNTY TAX ASSESSOR,
Si. LUCIE ~OUNTY, FLORI~A:
This ~s my decla~stion of Dom~cile and Citizenship i~ the Sta~e of Ftorids that 1 am filing this day in acoordanu and
~n confo~mity with Chapter 2~2, Section 222.17, Flcxids Statutes.
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I was formerly a legal resident of . U . - - , - -
, (City) ate)
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and 1 ~esided at ~.l _ l! .---G~~_~ ~ . Nowevet 1 have changed my domitile
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~(Street and Number)
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to and am and have been a bona fide ~esident of the State of Florida since - v~.- __l day of ~
o2Q 0 ~~~-S. F
_ - 19.~ ~ , and I reside at -
(Sfreet and Nu ber)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA -
a~d this statement is to be taken as my declarotion of citizenship, actual legal residence and domicile in the State of Florida.
(lnsert here any pertinent facts, such as sale of property o~ business, or relinquishment of employment
at fo~mer domicile, removal of family to new domicile, purchase of home, etc.)
f~''~..-~ e~ ' ~
~ ~ Ci~ FIL' ED AND RECORDED ` i
ST. LUCIE COUNTY. FLA.~ ~
AEC~RD VrRIFIEO
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'TO SEP - IW 9 : 22 ~ :
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ROGE. OITRAS • ;
~ CLERK CIRCUIT COUf~T .
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1 FURTHER G'fRTIFY that I will comply with all other requirements of a leyal resident of thia State.
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1 FURTHER CERTIFY that I have no intention to return to my forme~ domicjle, and I intend to remain in FORT
PIERGE, SAINT LUCIE COUNTY, FLORIDA, permanently. -
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~ v jt ll( (Name) ly V/~.S
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ca?dd~~:~
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,,$~wprt+ to;~rk}, wbscribed before me this day of , 19 .
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M Notary Public
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By D.C. My Commiuio~ expires -
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~T~ 1» iq~~crMd iN dtrplkaf~ and ori~inal Al~d whb Cl~ek Cirarif Carrf, and ~p1iuN wilh Tax AsMt~era
R- aooK 186 ~ 2585 T
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