HomeMy WebLinkAbout0901 O~claration ot Oomiail• a~d CltisMShip
TO THE STATE ANO COUNTY TAX ASSESSOR, ~
Sl. LUCIE COUNTY. FLORIDA:
This is my declaretion of Domicil~ ~~d Citis~~ship in th~ St~t~ of Flo?~d~ that 1 am fili~p this day in aotadana and
~n conformity with Chapt~~ 2?2, Sectior~ ~42.17, Florida Statut~s.
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I was formerly a leflal ~esident of ~ _
(City) (Sta»)
,
and 1 ~esided at - Howsvar 1 hava chanysd my domidle
(St~eet and Number)
to a~d am and have been a bo~a fide rssident of the St~b of Florida sinoe ~ day of
/
- . 19..~~, and 1 roside at ~
t and Number)
FORT NERCE, SAtNT LUCIE COUNTY, PLORIDA "
and this statement is to be take~ as my declaration of citizenship, actuat legal residenoe and domicils in the State of Florida.
(Insert here any pahinent facta, such as sale of property or business, or ~elinquiahment of employment
st fo~mer domicils, removai of family to new domicile, purchase of home, etc.)--
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~ I RIRTHER CEitTIFY that 1 will aomply with ail other rsquirsmenfs of a le~al ~ssidsnt of this State.
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~ I FURTHER CERTIFY that I have no intention to return to my former domicjle, and 1 intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ Qo RA _F ~ ~Name) ~ ~m!/ liJ ei,cE,~~
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~ Sworn #o and subscribed before me this day of , 19~
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~ .'~UA:CO~iRT ~Notary Public
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~ By D.C. My Commission expires
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~ .R~ • ie dupliut~ .nd o~inal fil~d whb u.~ic ciraih cev~f, and ~wpuc.F. wiN~ Tax A.....o.a
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~ $OOK 1~ PACE 8~7p ~
tao. 13
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