HomeMy WebLinkAbout2197 O~claration ot Domiclt~ and Citls~~ship ~
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TO THE STATE AN~ COUNTY TAX ASSESSOR, 2018i5
Sl. IUCIE COUNTY, FIORIDA: . ~
This is my declaration of Domitile and Citizenship in the Stste of Florida that f am fili~y this day in ~oootdanos and
~n conformity with Chapter ?22, Sedion 22?.17, Florida Statutes.
1 was forme~ly a legal ~esident of !~i__~__~___ _~Q~ SA_5
(~iy) . (Stats)...
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and 1 ~e:ided at __~•s However 1 have chsrped my domic}le
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(Streat and Number)
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to and am and have been a bona fide resident of the Stste ~of Florida since __~`S__ day of `
- , 19~, and 1 reslde st ~ ~O 1' 1 C ~ (7~i~~ •
(St~eet a~d Number)
FORT MERCE. SAINT LUCI! COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(I~se~~ here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.) _
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! FUR7HER CHtTlFY that 1 wil! oomply with all other rsqujrements of a layal rea'ident of this State.
1 FURTHER CERTIFY that i have no intention to retum to my former domiGte, and I intend to remain in FORT
PIHtCE, SAIN7 tUCIE ~OUNTIf, FLORIDA, permanently. .
ame)
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~+c••• ~ ~~ld wbsuibed before me this day of , 19,,~
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tT. b. a~«v+.d i~ d~puc.t..nd o.i~inal fi{~d wi~h u.rlc cira~it co~M, a~d duplkat. wilh Tax As.wo.a
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