HomeMy WebLinkAbout0757 O~claration ot Domicil~ and Citl:~~shfp
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. llK1E COUNTY, FtOR1~A:
This is my declaration of Domicile and Citizenship in the State of Flo~idb that 1 am filing this day in aooo~dance a~d i
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~n conformity with Chapter 222, Section ~~2.17, Florida Statutes. ~
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1 wes formerly a legal resident of -~~C~ - - -
u~(City) (S )
and 1 residad at ~~d j-~~~ ~~4~, However 1 have changed my domitile
(St~eet and Number)
to and am a?xl have been a bona fide resident of the State of Florida since ~vBQ.c__~. •Q' - dsy of
191
~and I reside at 0 ~ I
(S eet and 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 tha State of Horida.
(Insert here any pertinent fads, such as sale of property or busineu, or ~elinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
'i~lsti /`"~?•--~~~e2~~
FILEO AMO RECpRpEp
iT. WCIE COUNTY FL~,
RQCER FOITRAS
CLERK CIRCUIt 08URR.,~c,
RECORD YERIFIEO~~,~~~1,~
J~ ~ 10 os AN'11
2G2828
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; 1 RJRTHER C'HtTIFY that I will oomply with all other requirements ot a leqal resident of thls State.
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~ I FURTHER CERTIFY that I have no intention to ~eturn to my former domicjle, and i intend to remain in FORT
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~ FIERCE, SAINT LUCIE COUNTY, FLORI~A, permanently.
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~ (Name)
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~ :•'f.~ t.~~(rpy~.~ib?~~~~pscribed before me this day of ~ 1q ~j
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~ eY 0.C. My Commission expires
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~ Ro b~ ~x~ur~~d in dupliea?~ and ori~inal Al~d with C{~elc Greuit Courf, and duplieata wHh Tax AsNS~.)
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