HomeMy WebLinkAbout0841 D~claration ot Don~icil• and Citi:~nship
TO TNE STATE AND COUNTY TAX ASSESSOR, ~C j hQ
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Sl. IU~IE COUNTY, FIORIpA:
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This is my declaration of Domicile snd Citize~ship in ths State of Florida that 1 am filinq thii day in accordsnce and '
~n conformity with Chapte~ 222, Section 222.17, Florida Ststutes.
I was fo~merly a legal reside~t of -_~~~!s- L~!f~__!~ • _
(City) (S )
and 1 resided at ~~-L~ , However I have chan~ed my domiCile
(Straet and Numbe~)
ro and am and have been a bona fide resident of the State of Florida since day of
( ~ aow lPw~a,s c~ ~
- - - - 191L~_, and I reside et /O~ ST- ~u.e,..~., ~1=, T~~a..
(Street a~ Number)
fORT ~I~CE, SAINT LUCIE COUNTY, RORlDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Norida.
(Insert here any pertinen~ fads, such as sale of property or business, or relinquishment of employme~t
at former domicile, removal of family to r?ew domicile, purchase of home, etc.)
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C~ERIaC RpUIT~ O~jp1t
REQOAO vtR~ri~p~
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~ I FURTHER CERTIFY that 1 wil) comply with all other rsquirements 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
PIERCE, SAINT LUC1E COUNTY, FLORIDA, permanently.
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~ ~ 6 (Nsme) /
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~ Sworn to ,~•~~ibed before me this day of ~ ~z-~ •~z 19~
~ _'Ce`° : ~ ~
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~ • _ ;A 's Notary Public
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~ ey , - : ' ` D.C. My Commission expires ~
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~ ~ :7 • ~ ~
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~ R~ w~or~aMlyd ~ ih` ~pNtat~ and ori~inal fil~d whb tl~elc Ci~if Courf, and duplieat~ wiH~ Tax As~qer.) ,
~ '4 -~j
8 ~ . O :
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~ ,~o „ 800K
~ ~ 139 f
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