HomeMy WebLinkAbout0973 D~cla~atio~ of Oorniail• and Citls~nship 2(;~~; ~
TO TNE STATE AND COUNTY TAX ASSESSOR,
Sl, lUC1E GOUNTY, FlOR1~A:
This is my decla~ation of Domicils ar~d Citiz~nship in the St~t~ of Florid~ th~t 1 am filin~ this day in acoordance and
~n conformity with Chapter 222, Section 222.17, Florids Statutas.
I was formerly a legel ~asident of ~"1.L~- _
~ . Kity) (St~»)
and I ~esided at 1~ _ ~ . However I have cha~psd my domic,ile
(Street and Numbe~)
to and am and have been a bona fide ~e:ident of M?e State of Florida since day of
.
- ~ . 19~, a~d 1 reside ~ at ~
eet Nu~ber)~~
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FORT M~CE, SAiNf lUC1E COUNTY, lIORIDA ~ '
and this statement is to be taken as my daclaration of citizer~ship, actusl legal residence and domicile in ths Staro of Florlda.
(Insert here any pertinent facts, suth as sale of property or businesa, or relinquishment of employment
at former domicile, removal of family to ~ew domicile, purchase of tiome, etc.)
2G29:9 .
~ fIlEO RMO RfC~
S~ ROCER
POItRAf
CIERK CIRCUIt COURT
RECORO VERtFIEO
,~ui 6 10 44 AN'T1
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~ I RIRTHER CHtTIFY that I wiil aomply witfi all other requirements of a lepa) rssident of this State. ~
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1 FURTHER CERTIFY that I have no intention to retum to my former domitife, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ Sworn to and subsuibed beforc me this day of , 19~.
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pV ~~i1~~C~~ OURT Notary Public
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~ D.C. My Commission expires
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