HomeMy WebLinkAbout0769 ~~claratio~ ot Do~nicil• a~d Citlss~ship
TO THE SiATE AND ~OUNTY TAX ASSESSOR,
Sl . lUC1E COUNTY, FlOR10A: ~(,~3 ~
This is my declsrat~on of Domicile and Citizensh~p in the Stete of Florids that 1 am filin9 thi: day i~ accord~nce and -
~n confo~mity with Chapter 22Z, Sectio~ 222.17, Floride Statutes.
1 was fo~merly s legal resident of _ _ ~ _
(City) (Sts»)
p r •
end I resided at . _ ! ~l~ _ _ _ _ - - - However 1 have chanyed my domiC,ile
(Street and Numbe~)
to snd am and have been a bona fide resident of the State~of Florida since ._____~t.~~ dey of
--.~.~L~~s.cf 19 0 and I resi at C~. .
. , de
(Str and Number)
fORT PIERCE, SAINT LUCIE ~OUNTY, RORIDA
and this stateme~t is to be taken as my declarotion of citizenship, act~al legal ~esidence and domicile in the State of Florida.
(Insert here any pertinent fads, such as sale of properry or busineu, or relinquishment of employme~t
at former domicile, removal of family to new domicile, purchase of home, etc.)
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~ 1 FURTHER CERTIFY that I will comply with all other requirements of a(eyal resident of thi: State.
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I FURTHER CERTIFY that I have no intention to return to my former domiGle, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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Name)
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~ .:~'$`~wiD,td`p~id subscribed before me this da of , 19..~
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~ BY~ . ~ ~ " .C. My Cammission expires
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~ Re b~ ~aM~d in duplfut~ and oriqinal fil~d with C{~rlc Cira+it Court, and duplisah witl~ Tax As~or.)
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