HomeMy WebLinkAbout1117 ~l
O~claratio~ ot Domlcil~ and Cltis~nshlp
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TO THE STATE ANO COUNTY TAX ASSESSOR. 2~,~~~2
51. lUC1E COUNTY. FLORIDA:
This is my declaration of ~omicile snd Gitizen=hip in ths St~te of Florid~ that I am filinq thi: day in acoordanu snd
~n conformity with Chepter 222, Section 22Z,17, Florida Statutts.
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I was fo~merly a legal resident of . _ _
(Ciiy) (State)
and 1 resided at _.1l~isol~Ll~a1d d/~ U L~ However I have chsrped my domitile
(Street and Number)
to and am a~cl have been a bona fide ~esident of the Stata of florida sinoe -~LZ'• ~7 day of
- . 19~~and I reside at k%• ~'y- X a 9~
- (Street ued Numbsr
fORT MERC SAINT LUCIE COUNTY RORIDA r~ ~K~ ~ lQ ~
E. . ~
and this statement is to be taken as my declaration of citizenship, actual legal residence end danicile in the StaM of Florida.
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(Insert here any pertinent facts, suth as sale of property or business, or ~elinquishment of employment (
at former domicile, removal of family ro new domicile, pu~chase of home, etc.)
O tc-OL-
~~E ~No a
i~ ca~~~~,
06ER P 11
AiC~d Y[RIf1~~~~C
~ ~ ~ 8 8 0~ ~M'T!
203082
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~ I FURTHER CERTIFY that 1 will oomply w~th all othe~ requirements of a IeQal resident of ~this State.
~ 1 FURTNER CERTifY that 1 have no intention to retum to my former domitile, and I intend to remain in FORT
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PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently.
~ - ? /r~~~
~ (Neme) QS t c it 1~ o a r
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~ (Add~ess)
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~ :~~5~11ctji.to,-6ed"~v~4stribed before me this day of - , 19~ L.
~ • . ~ ~ f-
~ ' ~ -t~Q~' ~;OITR/tS
~ b~ C~R~~~O Notary Public -
t
8y ' D.~. My Commission expires
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(Te b~ ~e~hd in d~plisM~ and aioinal f~ wNh C1~ek Cira~it Caut, and drplk~h wi/b Tax A~~a
~ ,a i04!(~09 P~CE~„~,~.~
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