HomeMy WebLinkAbout2922 Declaration ot Do~nlcile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
S~. WClE COUNTY, FLORIDA~
This is my declaration of Dom~cile and Citizenship in the State of Florida that 1 am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
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1 was formerly a legal resident of ffl?-. lIe R n_~_t_i n!?_1 S '
(City) (State)
p ~ R
and I resided at ~ 1~ ~ ~0 W h S_ V~~?~ R_d_ However I have changed my domiSile
(Street and Number)
to and am and have been a bona fide resid~nt of the State of Florida since Se P 7• _ day of
I , 19__ 1 v, and I reside at ~.j .U S~' 1 ~ W A~ - ~ S ;
(Street and Number)
FQRT PlERCE, 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 Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinqui,hment of err?ployment
at former domicile, removal of family to new domicile, purcrase of home, etc.)
~h r~Ring C~~.~ ~d ~n PHhi.~c, ~e ti~o~,
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F ~,EO ~NO aECOaoEo
s~. ~uc~E couwnr F~~. a.,..J
CLE~C
~CUI CO~~t *~c~~v,.,C
IIECORO YEa~F1E0l+~'
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~ I FURTHER CER~IFY that I will comply with all other requirements of a lega) resident of this State.
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x I FURTHER CERTIFY that I have no intention to return to my fo~mer domi~ile, and I intend to remain in FORT
~ PIERCf, SAINT LUClE COUNTY, FLORIDA, permanently. ~ ' t
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~~a,~~~~^t'•,~~ . (Address) ~
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~ '~~~'~~Y~~~ G, day J e j
K _ N_. ~r~ 14 ~ r;ibed before me this of ~U. m_~ , 19 ~ 0
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~ ''•i=~i~. . '.h`
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" - ~ ~ URT -
Notary Public
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~ By ` ` _ / ~r_~«' ` ` ~ D.C_ My Commission expires _
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~ (To bs exscutad in dupliute and original filed with Clerk Circuit Court, and dupliute with Tax Assessor.) ~
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