HomeMy WebLinkAbout1298 Decta~atio~ ot D~omicil• a~d Citis~nship .
TO THE STATE AND COUNTY TAX ASSESSOR, ~~'1~Z
51. LUCIE COUNTY, FIORIDA: ~
This is my declarotion of Oomiule and ~itizenship in ths State of Florids that 1 am fili~fl thi: day in eco~~dance and
in tonformity with Chspter 222, Sectio~ 222.17, Florida Statutes.
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I was forme~ly a legal resident of ~_I~L~s-1~ -
(City) (State)
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and 1 resided at 0_Q.- However t have chsnged my domicGle
~ (Street and Number)
to end am and have been a bona fide resident of the State of Florida since ---~r_s~-`cl day of
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--~'l'(~- 19~, and 1 reside at ~ O ~ /Q.L,~~~~ ^.!...~ti~
~ . (5treet and Nurnber)
FORT PiERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual lega) residence and domicile in the State of Flo~ida.
(Insert here any pertinent facts, such as sale of property or busineu, or relinquishment of employment
at former domicile, remova) of family to new domicile, purchase of home, etc.)
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I FURTHER CERTIFY that I wilf oomply with all other requirements of a le~al resident of thls State. .
1 FURTHER CERTIFY that 1 have no intention to retum to my former domi~ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
(Na.me)
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~ a ~ , 1 ~AddfeSS~
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ii~~` ~~cy`
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~ • ' ~ ibad before me this ~ U dsy of ~D ~ ~ ~ ~ r , 19~
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• tp1~RT Notary Public
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By ~ ` .C. My Commission expires
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Re b~ ~x~evhd ie dvplieah and oei~inal Al~d whh CIKIc qra~il Co~rr1, and dupliub wifh Ta~t A~o~a
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