HomeMy WebLinkAbout0939 2U2~~~1
D~cl~ration ot Domlcll~ and Citis~nship
TO THE STATE ANO COUNTY TAX ASSESSOR.
51. IUCIE COUNTY, FLORIDA:
This is my declarstion of Domicile and Citis~nship i~ ths St~te of Florida that I am filin~ this day in aooordano~ and
~n conformity with Chapte~ 224, Sattion 224.17, Florids St~tutes.
1 was formerly a lega) resident of ~U~~ ~~`~G r0/? ~~w ~~~`sJ~`'y
(Ciy) (Stah)
and I ~esided at _~~O~eSwUQ t~ ~/e _ , However 1 have chanqsd my domidle
{Street snd Number) -
to and am and have been a bona fids resicient of the State of Florida sinoe day of
L~ S T , t 91 and i rosids at 1D0.~ J 8,~~~r /N~/f1~/ /L'~ti' ~iP.
- (Street and Number) -
FOItT MERCE, SAINT LUCIE COUN~Y, RORIDA
and this statement is to be taken as my declaration of citizenship, actuat lagal residena~ and domidle in the State of Florida.
(Insert here a~y pe~tir~ent facts, such as sale of property or business, or relinquishment of emplo~rment
~ at former domicile, removal of family to new domicile, purchass of home, etc.)
242951
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LUC1E COUMTTRFL~
. tlOCER POITRA: ~
CLEaR CIRCYI~ QOtIlIT
- RECORO vERIflEO
Ju~ 5 3 ~ PM'TI
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~ 1 FURTHER GERTIFY that I will oomply with all other rsqutrements of a lepal rssident of this State.
I FURTHER CERTIFY that I have no intention to retum to my former domicjle, and I i~tend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLURIDA, permanently.
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~ (Name)
~ ~0~~3 S~ ;ry ~i~o~.~ /~i
c~~x
(Addresa) ~
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~ Sworn to and subxribed before me this ~ day of , 19~.
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~R~'i't~URT Notsry Public
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~ gy _ i _ D.C. My Commission expires
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. 1i~ ' dupliuta anJ ori~inal Al~d wiM~ Cl~eic Cin~i1 Caref, and ~p~cat~ wilh Tax As~e~a
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