HomeMy WebLinkAbout0842 O~cla~ation ot Domiall• a~d Citls~nship
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TO THE STATE AND COUNTY TAX ASSESSOR. 2~~~U
Sl. lUC1E COUNTY, FLORI~A:
This is my da~iaration of Domicile and Citize~ship in ths State of Flo?ide that 1 am filiny this day i~ sccord~nc.~ a~?d
~n conformity with Chepter 222, Settion 222.17, Florida Statutes.
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1 was fo~merly a legel ~esidcnt of _
(Ciy) (Sta»)
and I resided at - However I have chanyed my domitile
(St~eet Number)
ro and am and have been a bona fide resident of the State of Flo~ida since • o~ da of
Y
- - - - . 19~v and I reside at - - - - - - - - L//, e~
• (Streat and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the Staro of Horida.
(Insert here any pertinent facts, such as sale of property or busi~ess, or ~elinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.) ~
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f lE0 AN~ RECOil~EO ~
LUCtE COUNtY :
itOCER POITNAi ~
RE~ppO YERIFIEO cOURt
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i I FURTHER CERTIFY thst f will comply. with a{I other rsquirements of a leqal resident of this State.
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~ I FURTHER CERTIFY that 1 have no intention to return to my former domicjle, and I intend to remain in FORT
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~ PIERCE, SAINT.LUClE COUNTY,-FIORIDA, permanently. -
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~ Sworn to and subscribed before me this day of , 19~.
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~ R ER POfTRAS
~ K CIRCUIT OURT Notary Public
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~ B O.C. My Commission expi~es
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~ Ro b~ ~x~cutod in duplicat~ and ori~inal fil~d wilh C{~elc CirwN Couef, and dupltcat~ with Tax AsMwor.)
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~ ° R ~89 $39
~ a~c~ Fr~GE
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