HomeMy WebLinkAbout1086 2U3t~0 ~ ~
D~cliuratfo~ ot Domicil~ and Citis~nship
TO THE STAtE ANO COUNTY TAX ASSESSpR.
Sl. tl1C1E COUNTY~ FtORID/1:
Thi: i: my declaration of Domicil~ a~d Citiunship in tM Stah of Horida that 1 am filirp this day in aooordanp a~d
conformity with Chaphr 222, Saction 222.17, Fiorida Statuhs.
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I was formerly a Ipal rosids~t af /
(rity) (St~t•)
and 1 rosided a! ~6~~ ~ L7ili+•~r-- . HowtvK 1 haw tharqid my dornic~l~
(Stn~f ar~d Numbar)
ro ar~d am and hsve baen a bw~a fide rosident of ths Stat~ of. qorida ainoe day of
~1~~'~ . 19~, and 1 r~side at U-~
(Stre~t aind Numb~r)
IAORT ~CE, SA1NT tUC1E C011NTY, RORnA
and this steMrr~er~t is ta be taken as my dedaretio~ of citi~snship, actual laQa! rssidenos and domicile in the State of Horida.
(Insert ~e any pertinent facts, such as sal~ of propsrty or b~siness, or relinquishme~t of emptoyment
at former domic;le, rsrrwvsl of family 10 ~ew domicite, purchese of home, ett.)
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i FURTHFR CHtnFY that 1 wiN oomply with al! ~ requir~nwn» of a lspal rasidsnt of this S»».
t FURTHER CERTIFY that I hava no intention to retum to my former domicjle, snd i inte~d to remain in FORT .
~~ERCE, SAINT~lUC1E COUNTY, ~IORIDA, pe~manently: J~ES O. DAYIS
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'~R,1'P,iM~d' .su~ibsd before me this daY ~ , 19~.
RO~ rORRAS
~T Notary Publk
BY . D.C. My Commistion ~xpit~s
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