HomeMy WebLinkAbout0084 .
~ Daclaratlo~ ot Domicll• and Citi:enship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FIORIDA:
This is my declaretion of Oomicile and Citizenship in the State of Florida that 1 am filinq this day i~ acoordance and
~n confo~mity with Chapter 22?, Sectio~ ~Z2.17, Florids Statutes.
1 was formerly a legel rosident of ___~'1«_~~.1.t21~Q- - -:m~~~~'~~
. (~ity) ~ (State) ~
end 1 rosidsd at s~,L~ - ~~G~._ However 1 have chan~ed my domidle
(St~esf and Number)
to end em and have been a bona fide ~eside~t of the State of Florida since - day of
e,~ u
, 19~Q, and I ~eside at ~;Y ~ o~~
(Straet and Number)
fORT PIERtE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actval legal residence and domicile in ihe State of Horida.
i
(Insert he~e a~y penine~t facts, such as sale of property or business, oi relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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~ OOM'~Ai
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~ 2004~5
~ 1 R1RTIiER CERTIFY that 1 will oomply with all other requiremenh of a le~al reaident of this State.
I fURTHER CERTIFY ihat I have no intention to retum to my former domiGi~e, and I intend to remain in FORT
PIERCE, SAINT IUCIE COUNTY, FLORI~A, permanently.
~{'1 1'. ~ ~ ~~~%'s?i xLA/lm2 ~s..~~„~_
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.~~~ibsd befor~ me this dsy of , 19.ZQ_.
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•
! CONRT Notary Public
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~ BY ' «D.~. My Gommiuion ~xpir~s
R~ M~aM~ M~cN~ ~wd Mi~Mal AI~ wilb CIMk CiraAf Gwt, anr drplis~N wi* Tax A~~,?
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