HomeMy WebLinkAbout0364 Declaration ot Domicile a~d Cltise~ship
TO THE STATE AND COUNTY TAX ASSESSOR, ~~8~
Sl. IUCIE COUNTY, FIORIDA: •
This is my declaration of Domicile and Citizenship in the State of Flo~ida that I am filing this day in accordance and
fn conformity with Chapte~ 222, Section 222.17, Florida Statutes. ~
~ - .
1 was formerly a legal ~esident of ~S EM O V AI / ~ I/v~ • _
, (City) (State)
and 1 resided at ~~~Q~Q_Q_ However 1 havechanged my domiCi~e
(Street and Numbe~) ~
7,~
to and am and have been a bona fide resident of the State of Florida since - day of
f--- - . 192Q, and 1 reside at _ ~0 ~ ~O ~ ~7 r
k
/P ~1'~~ ~ -
(Street and Number)
FORT WERCE, SAINT LUCIE COUNTY, RORiOA
and this statement is to be taken as my detlaration of citizenship, ach~al legal residence a~d domicile in the State of Flo~ida.
(Insert here any pertinent fads, such as sale of property or business, or ~elinqu9shment of employme~t
at former domicile, removal of family to new domicile, purchase of home, etc.)
f33~ND~~ Sh~~/P~f14lV N/i ~~oi(J y~S.
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DRE~Q~
RLOORO Y[RI?EO
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I FURTHER CERTIFY that I will cornply with all other requirements of a(e~a) resident of this State.
I FURTHER CERTIFY ihat I have no intention to retum to my former domicjie, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. S N- E. NEI~S~DT _ ~
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(Name),
~ ;c~:?:r1,, ~00 /`~df~'Si
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~ ,•L ~.:.:..;,Cp'~'., (Address)
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• • :'ti?~ t Gt ~ ~y~
~ bvibor~A`tc~`~so~scriiaed before me this ~a ~ day of , 19~
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~ Notary Public
By _ D.C. My Commission expirea "
(To b~ ~x~cut~d in dupliwt~ and ori~tnal fil~d wHh CIKIc G?wH Cou~t, and duplfeat~ wjth Tax Ass~ssor.j
a~K 188 ~ 364
nto. ! s ;
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