HomeMy WebLinkAbout1029 ~u3t ?i~
O~cla~atlo~ ot Oomiail• and Citls~nship
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FlOR10A:
This is my daclaration of Oomicile a~d Citi:~~ihip in 1M Stat~ of Florid~ thst I am filin9 this day in aaordanot e~d
~n conformity with Chapts~ 22~. Section ~22.17, Florida Statut~s.
1 was fo~me~ly a legsl resident of _ -
(~ity) (St~») 4
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and 1 rosided at ~Q~_ ~2-_ .T ~0'~~t~1~.- Now~ver I have chanq~d my domic,~le
(Str~et and Number)
ro a~d am and have been a bona fide resident of tl~e Stste of Florida since _!i~f~ ~~-d'~
0- dey of
, 19_-, and 1 rsside at
' (Shaet and Numbe?)
FORT MERCE, SAINT lUC1E COUNTY, fLORIDA
and this statement is to be take~ as my declaration of citizenship, actusl legal residence end domicile in the State of Horida.
(Insert. here any pertinent facts, such as sale of property or business, o~ relinquishment of employment
, at fo~mer domicile, removal of family to new domicile, purchase of home, etc.)
2t~3018
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CLERK CIRCUiT COU11T ~
RECOItO YERIiIEQ~
~All 6 3 22 ~I'7 ~
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~ I RIRTHER GERTIFY that 1 wil) oomply with all other requiraments of a le~al rasident of this Stats.
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~ I FURTHER CERTIFY ihat 1 have no intention to rotum to my former domiCile, and 1 intend to remain in FORT
PiERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. y C- ~~v~'' ~
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~ Sworn to and subscribed before me this ~ day of , 19
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~~I~Cf11f'i~UkT Notary Public
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~ ~y - ~ ' ' D.C. My Gommiuion expires
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~ (T~y •ip•,:(v~lie~h and oti~ina! $I~d wiM~ CIKk qrwk Coue~, and duplitaf~ wifh Tax AM~swr.)
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