HomeMy WebLinkAbout1010 ~cia~atio~ 01 Domicil• a~d Citis~~ship ~~~3(lOz
TO THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE COIINTY, FIORIDA:
This is my declaration of ~omicile and Citize~ship in the Sta~e of Florida th~t I am filinq this day in aaordanc~ and
~n conformity with Chapter 222. Section 2?2.17, Florids Statutes.
.
I was formerly a legsl resident of ~ _
(City) (Stah)
and 1 ~esided at - y~+" • Nowever 1 hsve cha~psd m domitile
.-y~ Y
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _ day of
. 19~, a~d 1 reside at ~ •
(Street and Number)
FORT PlERCE, SAINT lUClE COUNTY, RORIDA
and this statement is to be taken as my declaration of cit~ze~ship, actual legal residenoe and domicile in ths State of Florida.
(Insert here any pe~tinent facts, such as sale of property or busineu, or relinquishment of employment
at formar domicile, removal of family to new domicile, purchase of home, ett.)
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~ i FURTHER ~ERTIFY that 1 will oomply with all other requirements of a lepal resident of this Stste.
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1 FURTHER CERTIFY that I have no intention to retum to my former domicjle, and I intend to remain in FORT
RIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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~Cit$,,si~u~i~ed before me this day of 19
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~ 6y ~ D.C. My ~ommission expires
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~ Ro bi ~xsart~d ie duplicat~ and ori~inal fil~d whb Cl~rk Grcuk Ceu~f, ~nd dupli~ah wNl~ Tax ~ As~wor.)
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~ i89 ~1007
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