HomeMy WebLinkAbout2981 Declaration ot Domicile ahd Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Si . LUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
~n conformity with Chapter 222, Sectio~ 222.17, Florida Statutes.
~~,1~~.
I was formerly a legal resident of ' 1~ -
(City) - - (State) s
and I resided at !_~G~ ~ However I have changec~ my domitile
(Str~et and Number)
!o and am and have been a bon~ fide ~esident of the State of Florida since ~ 4~ - - day of
.
, 19~~~ _!!~f _vr - • / ~-tL~~
_ . , and I reside at
(Street and umber)
~'t Ntr c:•A
FORT PIERCE, 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 rel~'nquishment of employment '
at former domicile, removal of family to new domicile, purchase of home, etc.)
/ 1 u.' j y~_c.-~ 'Z~ec.-~~ ~~t-t _f~C~'_~ -
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F LEO AND REC
t~.IUCtE COUNTY
ROCEa POl~RAi
CIERK CIRCUtT C0Y~~~, ~
IlECORO YERIFIEO~
,Y
; r~ 2 s 48 aM 7~
$ 2C040~ ~
f5 , ~
3 ~
~ t
$ 7
~ s
~ I FURTHER CERTIFY that t will comply with all other requirements of a legal resident of this State. ~
~ ~
~ I FURTNER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIOA, permanently. ~
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; .~iNr~c,;;~ (Address)
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~ ~ 1?xd before me this - day of ---!YG vP ~?^~s r; ,~9_~G; ~
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, t ` 1 Notary Public '
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~ By ~ -C D.C. My Commission expires
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(To b~ ~xscuNd in duplicat~ and ori~inal filed with Cl~rk Grcuit Court, and duplicate with Tax Assessor.)
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~ .,a ,s ao~187 PACE298p
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