HomeMy WebLinkAbout1147 Oiciaration ot Domicll• a~d Citiz~nahip
TO tHE STATE AND COUNTY TAX ASSESSOR. 2(j31O2
51. IU~IE COUNTY, FIORI~A:
This is my decleration of Domicile a~d Citizenship i~ the State of Flo~ida that 1 am filin~ this day in aooordance and
~m m~formity with Chapte~ Z22. Section 222.17. Fiorida Statutes.
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I was forme~ly a legal resident of b~' _
(City) (State)
and 1 resided et ~ ~ `t_.G »u~i1_-~c
/a-t However 1 have chanfled my domivle
(Streef and Number) -
to end am and have been a bona fide resident of the State of Florida since ~~1C
~ day of
~ ~ Q~
_ - _ - - , 19 ~ and ! reside at
(SNeet a Nu~~
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FORT PIERCE, SAINT lUC1E COUNTY, FLORI~A
and this statement is to be taken as my declaration of citizenship, actual legal residenoe and domicile in the State of Horida.
(Insert here a~y pertinent facts, such as sale of property or business, or ~elinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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FtlfO ~ND RFCOq@Ep
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CLfR~ ClRC~tT~AS l~i.
RECOItD VERIFIEp~
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I FURTHER ~ERTIFY that I will oomply with all other requiremants of s le~a) resident of thls State.
I FURTHER CERTIFY that I have no intention to return to my former domi~jle, and I intend to remain in FORT
PIERCE, SAINT LUC{E COUNTY, FLORIDA, per?nanently.
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~ (Name) S m: ~
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^.5~~;fd'~id~.~rb~tribed before me this ~ day of i~-< <<c , 19~
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~ .~,.4 t~lb~ Notary Public
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s~ ey" < < D.C. My Commi:sion expires
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s Ro b~ tx~arlyd in duplicah and oeioina! Hl~d whh q~rk Grwit Cou~, and duplicaN wiN~ Tax A~o~.)
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