HomeMy WebLinkAbout1195 2t ):31;3:3 ~
acla~atlon ot Domicii• ~~d Citis~~ship
TO THE STATE AND COUNTY TAX ASSESSOR,
51. IUCIE COUNTY, FlORIOA:
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This is my decla~ation of Oomicile and Citi=enship in th~ St~t~ of Flo~ida that I am filinq this day in ecoo~danc~ and
~n conformity with Chapter 222. Section 222.17, Flo~ida Statutes.
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I was formerly a iegal resident of _~1~~?'vu~ ' ~~Z~~ _
(City) )
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and 1 resided at _ L- _ However 1 have chan9ed my domitile
(St~eet and Number)
to and am and have been a bona fide resident of the Stste of Florida since _ t day of
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, 19~, and I reiide at
(Street a Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residance and domicile in the Stab of Horida.
(Insert here any pertinent facts, such as sale of property or busineu, or relinquishment of employment
at former domicile, remova! of family to new domicile, purchase of home, etc.)
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FILEO ANO RECOROEO
• SL ~UC~E COUNTY FLA.
' ROCfR POtTRAS
CLERK CIRCUIT COURT
RECOAO YER~FIEO
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~ I RJRTHER CERTIFY ihat I will oomply with all other raquirements of a le~al resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT IUCIE COUNTY, FLORIDA, permanently. Geor~ e ,~o~t~{ /Q
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~ (Name)
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(Address)
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~ Swom to at)d;subscr~bed beforc me this day of , 19 .
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~ . Notary Public .
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By D.C. My ~Commiuion expi~es
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(To b~ iw.~h1~4~~and ori~inal Al~d wilh Cl~eic qra~it Co~et, snd dupll~al~ wifh Tax Asws~.)
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~ .-r.,,.. o R 189 ~-~.192
~ auaK PA~c
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