HomeMy WebLinkAbout0892 aalaratio~ ot Oo~nlall~ a~d Cltiz~nship
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TO THE STATE AND COUNTY TAX ASSESSC)R, '
si. wciE couNnr, F~oR~oA: 2o2~2i
This is~ my declaration of Domicile and Citizanship in th~ Stats of Flwida that 1•m filin~ this day in aooordana~ and
in confwmity with ~hapte~ 222, Section 2~2.17, Fiorids Statutts.
I wes formerly a legal resident of ~ - ~
(Cj~Y1 )
and I rosidad at However 1 have than~sd my domitjle
(Street and Number)
to and am and have been a bona fide resident of the Stats of Florida sinoe da of
, 19.~, and I mside at Ct~Lp
(Sheet a umbsr)
FORT MERCE, SAINT LUCIE COUNTY, RORtDA
and this statement is to be taken as my dnclaration of citizenship, actual legal residence and domicile in the State of Horida.
(Insert here any pertinent fads, such as sale of property or busineu, or relinquishment of employment
at former domitile, removal of family to new domicile, purchsse of home, ett.)
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~~IE CSUNT~~~
RG6EIl PO1T~At
c~~~x c~acwt oou~t
' RECORO VERIFIED ~
,~ui 5 !0 31 I~'11
2.C~2921.
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~ 1 RIRTHER CERTIFY that I wii) oomply with all other requirements of a Is~al resident of this Stat~.
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~ I FURTHER CERTIFY that 1 have no intention to retum to my former domi~ile, and 1 intend to remain in FORT
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~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, perma~ently.
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(Name)
~ /~ir cc/ //~E f+/
(Address)
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~ Sworn to;,~and w4suibed before me this da of ~ ' , 19~.
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~ ' v; r~K;.C~~b1~~T.~; Notary Public
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~ By % cq. f ` D.C. My Commission expires
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~ ('h . M dupu~.l..nd o~i~inal fil~d wilh q~elc uraiif c~ewr, .nd duptk.a vrhk T.x At....e.a
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~ ,a iOOK ~89 PI~CE O~t
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