HomeMy WebLinkAbout1060 D~ciuatlo~ of Oon~lall~ ~d Citls~nship .
TO THE STATE ANG COUNTY TAX AS.SESSOR,
Sl. lUC1E COUNTY, FtORIDA: .
This is my declaratio~? of Domicile •nd CitiZtnihip in th~ St~t~ of Horid~ that 1~m fili~p this day in aaoordano~ and
in oonformity with Chapter 22Z, Settio~ 222.17, Florida Statuhs.
1 wa: formerly a leyal resident of •
i1y) (Sfah)
end I residad at _~_~.t.~~2Z Howevsr i have charp~d my domidl~
(Street and Numbar)
ro and am and have been a bona fide resident of the_ Sts» af Fiorida :inoe day of
, 191Q, and 1 roside at `~j'~
(Strsst and Number)
PORT MERCE, SAINT LUCIE COUNTY, RORIDA -
and this atatement is to be taker~ as my dedaration af citizenship, actvat 1a9a1 residsnos and domidle in the Stats of Florida.
- pnse~t here any pertinent facts, such as sale of properry or business, or relinquishment of emplaym~nt
at fomner domicile, removal of family b new domiaie, purchase of hom~, etc.)
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i~~U1~OtE C ~OYNTYRFtA.
110CER POITRAf
RE~ROYERRfI[0
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I RJRTHER ~ERTIFY that 1 will oompty wltii sl) offier nquir~nts of a Ipal r~ident of fhis State.
1 FURTHEi~ CERTIFY that I have no intention to retum to my former domicjle, and ! inten~d fo remain in FORT
PIERCF,,~fNT LUCIE COUNTY, FIORIDA, permanently.
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~ ~n ro and substribed before me this ~ day of , 19
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C~CUR~ Notary Publk
~ By ~ D.C. My Commiuion expi~as
(T~ b~ ~x~arlri is d~pikal~ a~ ~i~iw~1 f~el wilb CIMic CMr~il Cewf, ~~IieaN wilb Ta~c A~ra
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aoK o~ 057.
No. I 3
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