HomeMy WebLinkAbout0903 2t~~32f3
D~cla~atio~ ot Dom1a11~ a~d CitisMShip
TO THE STATE AND ~OUNTY TAX ASSESSOR.
51. LUCIE COUNTY, FLORIDA:
This is my decla~ation of Oomicile and Citizenship in th~ Stat~ of Florida that 1~m filin~ this day in acaordana ~~d
~n aonformity with .~'.hapte~ 222, Settio~ 222.17, Florida Statutts.
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1 was formerly a legal resident of -
(tity) (Stat~)
and 1 ~esided a ~f a 4 ' . However I have chan~sd my domic3le
(Street and N ber)
to a~d am and have been a bona fids resident of tha State of Florida sinae dsy of
- . 19~~, and I reside at a~D`1/(lo?r'~ AT ~
. (5heet and Number)
FORT PtERCE, SAINT LUCIE COUNTY, FLORIDA
and this stateme~t is to be taken as my declaration of citizenship, actual le~al re:idente and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of propetfy or business, o? relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
/
. 20~928
~ RO~ER
PQ
TRA~
~ERK CIACYIt COIMT
IIECOR011EaIF1E0
; ,i~ 5- I! s~ ~'11 _ ;
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~ I FURTHER ~ERTIFlf that I will comply with a!I other ~equiremenfs of a leqal resident of thls 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 IUCIE COUNTY, FLORIDA, permanently. ~4'T' ~ov~~
(N )
u
~ (Address)
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~ Sworn to and subxribed before me this S day of , 19 .
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~ .:::.~~t~:, -
~ ROGER ~S `
~~~~~Ip~, Notary Public
O,
~ By ~ ' f _ _ D.C. My Comrniuion expi~es
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~ (TO bi' ~ - a~d ori~inal fil~d wilh CINIc qra~it Ceue~, and duplica/s wi!!~ T~x At~t.)
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