HomeMy WebLinkAbout0917 I~sclaration ot Daniail• and Cltis~nship
TO THE STATE AND ~OUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FIORIDA:
This is my decls~atio~ of Domicite and Citizenship in th~ St~t~ of Florida th~t I am filinq thi• d~y in aooo~dsna and
in conformity with Chapter 2?2, Sectio~ 22Z,17, Florids Statutes.
1 was fo~merly a lega) ~esident of ~45E-~ ~ _ - - ~ _
(Ciy) ~M)
and 1 resided at ~~~-~t How~var 1 have charpsd my domicjie
(Street and Number) ~
b and am and heve been a bo~a fide ~esident of the State of Florida since r r s day of
- , 19~0 and I roside at ~r,~e..~l C~-«.+--~ 1°~.~+~-~
(5treet arx! Nu )
~
fORT M~CE, SAlNT tUCfE COUNTY, RORIDA . ~
and this statement is to be taken as my declaration of citizenship, actual la~al ~esidenoe a~d domicile in the State of Horids.
(Insert here any pe~tinent facts, such a: sale of property or business, or telinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
• ~s~~~~
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L~IE COUNTttR~~
~ CLERK~C
RC~i~1T 0lN11
1tECORD YERIf1Ep
~ 5 2 ~a PM'll
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~ , 1 FURTHER CERTIFY that I will oomply with all other roquirements of a le~al resident of this Staro.
1 FURTHER CERTIFY that I have no intention to return to my formrr domicjle, and I intend to remain in fORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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y ~ (Name) .
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~ :-+;Swbr~r.1~~~~suibed before me this ~ day of ~ ~c < , 19
'Y ; r.: R~.
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~ ~~T > Notary Public
i t a 1i!
~ BY . j` D.C. My Gommission expires
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(To b~ ex~cut~d in duplicab aad ori~inal fil~d whb C~ic p~ Coue~, and duplical~ whb Ta~c A~~.I
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