HomeMy WebLinkAbout0779 ~acla~ation ot Oomi~il• a~d Citis~nship
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TO THE STATE AND COUNTY TAX ASSESSOR, ;
51 lUC1E ~OUNTY, FIORiDA: ~
2~;28~~~~ !
This is my dcclaratio~ of pom~cile and Citi:enship in the Stete of Florida that 1 am filinq this dsy in scoordance snd
m co~formity with Chapte~ 222, Section 2?2.17. Flo~ide Statutei.
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I was fo~merly a legal resident of t~_ _
(City) ($t te)
and 1 ~esided at _
l 70 - ~ --3 ~ _ _ - However 1 hsve chanfled my domicjle
(Straet and Numbe~)
ro and am and have been a bona fide resident of the State of Florida since _ day of
- - . 19?~, and 1 reside at _?O - c~ O ~~lz~i. ~
(Street and Numbe?)
FORT ~IERCE, SAINT lUC1E COUl~lTY, RORIDA
and this statement is to be taken as my declaretion of citizenship, actual legal residence and domicile in the Stab of Florida.
(I~sert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at forme~ domicile, removal of family to new domicile, purchase of home, etc.)
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j 1 FURTHER CEitTIFY thst 1 will comply with all other requirements of a leqal resident of this State.
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~ I FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT
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€ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently_
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; (Name)
E - ~~ac »,~c b. ~a.r/~~.~ Sv..
' ~d ~ ~a~~-G~ti 3
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` (Address)
~ . SMic~th 1v qcx! wbsaibed before me this day of 19..,
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F • .+~o~`~tr~?s
~ ' ' ~~~R~ f~lotary Public
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gY._ D.C. My ~ommission exp~res '
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~ R~ Yi'~baari~d M d~piicN~ and e~i~inal Al~d witb Ctwlc G?wit CouK, and duplicat~ wHh Tax A~e~.)
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