HomeMy WebLinkAbout0962 O~la~atlo~n ot Ooml~il~ and Citl:~nship
- 2C1~;8
TO THE STATE ANO COUNTY TAX ASSESSOR.
Sl. LUGIE COUNTY, FtOR1~A:
This is my detla~ation of Oomicile and Citizenship in ths St~ts of Florida that 1 am tilin~ thi= dey in atoordanos and
~n confo?mity with Chapter 222. Ssction. 222.17, Ftorida StatuMs.
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1 was fo~merly a legal ~eside~t of
(Ciy) (Stah) .
and 1 resided at . However 1 hsve charqsd my domidle
(Street and Number)
to and am and have been a bona fide resident of the Stste of Florida since ! ~~y of
- . 19~, and I roside at 3 3~ ...~U ~~fG.fi~
(Street and Number)
FOR~- PI~CE, SAINT WCIE COUNTY, RORiDA
and this statement is to be taken as my declaration of citizenship, attuaf legal ~esidence and domitile in the State of Horida.
(Insert here any peninent facts, such aa sale of propery or busi~ess, or relinquiihment of employme~t
at former domicile, removal of family to mew domicile, purchase of home, etc.)
1Vi~rtat E~mst6 aai Ilalmt~j? .
Dsao!'rio
iT. l~lE COUNTY F~~.
1lOCER ?OITRAf ,1
ClE1tR CIRCWT OUAT ~.r^•'
RECORO YERIFIEO~
J~ 6 i0 os ~M'TI
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~ I FURTHER CERTIFY that I will oompl witfi all other r ulrements of a 1 al resident of this State.
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I FURTHER CERTIFY that 1 have no intention to return to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY; FLORIDA, pe~manentfy.
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~ :~~~My~ ~~cribed before me this day of , 191 L_.
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~ -a : Notary Public
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~ By D.C. My Commission expires
.
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(To b~ ~x~wt~d ie duplieab and ori~inal Al~d wilb CIMk Cirwk Couet, awd dupllah wilh Tax Ais~sr.)
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