HomeMy WebLinkAbout2040 Declaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
~l. IUCiE COUNTY, FlORIOA:
This ~s my declaration of Domiule and Citizenship in the State of Florida tEiat I am fil~ng this day in accordance and
:n conformity with Chapte~ 22'2, Section 22~.17, Florida Statutes.
I was formerly a legal resident of Long Island i~ew YorK _
(City) (State)
and I resided at 126. O~ean Ave. However I have changed my domiu~e
(Street and Number)
ro and am and have been a bona fide resident of the State of Florida since 13 th day of
- October , i9_70 , and I reside a~ . 812 ~:1 Rancho Dr. _ ;
~ (Street and Number) ;
FORT PIERCE, SAiNT lUC1E COUNTY, fIORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
~~~~^er ~iomicile, removal of family to new domicile, purchase of home, etc.)
(Schoel Children)
Darren h:ichael - lst Grade FILED AND RECORDED'
ST, LUC1E COUNTY, FLA.
c<F ~'Cf=f'• V~R!~'Ffl
199`752
'?0 OCT I S AM I I: y 0
~Y6~
I :O~;F: ~ ?OtTRAS
- CLERK CIRCUIT COURT'
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~ I FURTHER ~ERTIFY that I will comply with all other requirements of a legal resident of this State.
~ t FURTHER CERTIFY that I have no intention to return to my former domic,ile, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. Ba1'baY's CaII'.p (1'it~Y'S Ph212p ~ :
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~ Sworn to_and subscribed before me this 15th _ day of -._-____Q~~QbeT , ~q~_,
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~ ~ ~ ~ ~ Notary Public
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8y - ~ D.C. My Commission expires _
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~ (To bjt,i~~ ~~licate and ori~inal fil~d witb CIKk Circuif Court, and dupliuts with Tax Assessor.)
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?~do 13
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