HomeMy WebLinkAbout1056 D~alaration ot Oomlatl~ a~d CltisMShlp
TO THE STATE ANO COUNTY TAX ASSESSOR. 2Qnn~o
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s~. ~uc~e couNnr. ~oRio~:
This is my d~cluation of Domicil• and Citiz~nship i~ tM Stat~ of Florida that 1~n+ filin~ thi: d~y in aooord~no~ a~d
i~ conformity with Chapte+ Z22. Sactlon 222.17, Flaids Statuhs.
I was formerly a leqal ~esid~nt
KitY) ~ (Sta»)
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a~d 1 ~esided at .~i'`••~•• /O7 -/~~:.~..,I' /L~-~-/~. _ . However 1 have charqsd my domkik
(Straet and Number)
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ro and am end have beer? a bona fids roiident of the Sts» of FlorWa sinos r day of
. 19~, and I reside at 2 s Z ~ •~e.~.•~-t c.F .
(Stre~t and Number)
l~ORT MERCE, SAINT lUC1E COUNTY. RORIOA
and this statement is ro be taken as my declaration of citizenship, actual leyal residenos and cbmicile in the Stats of Horida.
(Insert_ he~e any. peninent facts, such as sale of propem? or business, or rolinqu+shment of employma~+t
at former domicile, removal •of family to naw cbmiciia, purc~ase of hon?e, etc.)
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~ 1 FURTH~R CERTIFY that 1 will aomply with all other rsquir~msnts of a Ipsl rosident of this State.
1 FURTHER CERTIFY that 1 have no intention to return to my former domicile, and 1 inbnd to remsin in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIOA, permanently.
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•';S~~n_ t~;~r~d substribed before me this day of 19~.f
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~q{!tT Notary Public
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$ir~'' D.C. My C,ommi:sion expires .
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_ - i~ d~plic.~. a~+i .~M.I Hl~d a?i~l~ a..lc ckwit c.w~, .nd d~lk.~. Tax A.......a
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