HomeMy WebLinkAbout1020 2~j3n11~
- O~cla~atlon ot Domicll• a~d Citi:~~ship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IIKIE COUNTY, flOR1~A:
This is my declarotion of Domicile snd Citizenship in th~ Sts~s of Florida th~t I am filinq thit day in aooordanu end
confo~mity with Chapte~ 242, Section 222.17, Florids Statut~s. ~
~
/
1 was formerly a leqel resident of a^'~ c _
(C~y) (Sta»)
and 1 rosided at ~ _ ~ ~ l ~ However 1 have chan~ed my clomic,ile
(St~eet and Number)
ro and am and have been a bona fide reside~t of the State of Florida since Y~~ _ l~ 7n day of
~
- - - 19 end 1 reside et ~ ~1 ~ ,/~tS~ilJ~. ~ 0~ •
. (Street and Number)
FORT r1ERCE, SAINT tUCIE COUNTY, RORIDA
and this statement is to be taken as my declarotion of citizenship, actual leflal reside~ce and domicile in the State of florida.
(Inse~t here any penine~t fads, such as sale of property or busi~eu, or relinquishment of employment .
at formar domicile, removel of- family to new domicile, purchase of home, ett.)
203011
fIlEO AND RE R
~T.ILtORER
PO'IT~ItA~:
CLERK ClRCWT.....~~~j~
#ECORD YERIFtfp ~ '
~IM 6 2 ~9 ~'1 ~
f
t
~ .
t
~ 1 FURTHER CEltTIFY that I will aomply witfi all other requirements of a le~al resident of this State.
c •
~ I FURTHER CERYlFY that 1 have no intention to return to my former domicjle, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~Q~p/~ Ar,,,,~ ~rA ~'a
- ~C~~ ~vs~z~ ~-~t
~ (Name)
~
~
z
~ (Address)
~ ~
~ Sworn to and subxribed before me this ~ day of , 19~.
~
~
~
~
~ ~ ~~~tiu~:r,.r~~,
~ , ~~~~i
~ Notary Public
f
.
~ By ; O.C. My ~ommiuion expires
_ • -
~ r : ~~s . t ~
. - ~ ~ ~
i ~
~ l~~b1~-, _ry ~-`~Acsh and ori~inal Rl~d with Cl~c C•irai~ Courf, and dupllut~ whh Tax Aau~or.)
~ ~f. ;~.::~`;1~'~~ ~ R 1b9 PAGf ~.0~.7
~ ~ , 3 aocK
~
~ _ : ,
_ , * ~uf.