HomeMy WebLinkAbout0251 Oecla~ation ot Don~icile a~d Cftisenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FLORIOA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 sm filing this day in accordance and
in conformiy with Chapter 222, Section 242.17, Florida Statutes.
1 was fo~merly a legal resident of I,~11~~_ v- -
(Ciy) (State)
and 1 resided at _ r~ ~'id~e ~wd However 1 have changed my domicile
(Street and Numbar)
to and am a~d have been a bona fide resident of the Stste of Florida since D~n~r id - dsy of
_ . 19
T~ , and I reside at 311 So• 21~ Stte~t
(Street snd Number)
fORT PIERCE, SAINT LUCIE COUNTY, RORIOA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
(Insert here any -~ertinent facts, such as sale of property or busineu, or relinquishment of employment
at former d~micile, removal of family to new dorr~icile, purchase of home, ett.)
~ili~ !or ha~sd~ad ~aorp~ien
iT~EUCIE COtEfNTY r~~ .
~ioc~ ~cui
aoV~T ~
~ IlECOlEI~ VE~?FI[0
OEC ~8 10 00 ~?'14
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1 FURTHER CERTIFY that I wil) comply with al) other requirements of a le~al resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~ L~
(Na r?l~z Lrlesid ,
i~ _ 'S
~ ~ ~ . (Address)
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~ oa?,~~sybstribed before me this ~ dsy of ~a~e! , 19 ~
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- ``.i~~qR COWt Notary Public
_
- gy D.C. My Commiuion expires
(To b~ ~x~cut~d in dupliut~ and ori~inal filad wifb ClKlc Grwk Covrt, and dupliut~ wHh Tax Aswaor.)
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No. 13 ~JGC~~ fa~~ 25~.
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