HomeMy WebLinkAbout2094 ~ecla~ation ot Oanicil• and Citis~nship
TO THE STATE AND GOUNTY TAX ASSESSOR. ~
si. ~uciE couNnr. F~oR~oA: 201'77'1 ~
This is my declaratio~ of Oomicile and Citizenship in ths State of Florida that I em filin~ this dsy in aooordanoe and
in confo~mily with Chapter Z22, Section 222.17, Florida Statutes.
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1 was formerly a legal resident of
(Ci ) (State)
and I resided at `id~
"~~12~~~~ „s'~• Nowever 1 have chsn~ed my domidle
(Street and Number)
to and am and have been a bona fide resident of the Stab of Florida sinoe J 3 dsy of
//ds~`~~l~ , 19~~ , and I reside at ~ O~
(Street and Number)
FORT M~CE, SAINT WCIE COUNTY, RORIDA -
and this statement is to be taken as my declaration of citizenslvp, actual legal residence and domicile in the Staro of Florida.
(Inse~t here any pe~tinent facts,. suth as sale of property or busineu, or ~relinquishment of employment _
at former domicile, removal of family to new domicile, purchase of home, etc.)
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, FIIED ANO REcORQ~ ~
iT. li1Ci RCPO~=
CIER~K ClilCiilY C _
QEC4RD YEIt~F1EA. ~1
DEC 7 ~ ~6 -
~ 21~1~~'1
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i FURTHER GfJtTiFY that I will oomply with all other requirsments of a le~al resident of this State. _
1 FURTHER CERTIFY thst 1 have no intention to retum to my former domiCile, and I intend to remain in FORT
PIERCE, SAINt IUCIE COUNTY, FLORIDA, permanently.
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- ribed before me this da of __~~![,d.~~tnt~GCG~- , 19 .
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