HomeMy WebLinkAbout1213 acla~ation ot Domi~il~ and Cftls~nship
TO THE STATE AND COUNTY TAX ASSESSOR, ~U.31i~~~
Sl. lUC1E ~OUNTY, FIORIDA:
Th~s is my decla~etion of Oomicile sr+d Cititenship in the State of Florid~ that I am filinq this day i~ acoord~nc~ snd
~n conformity wilh Chapte~ 222, Section 2~2.17, Florid~ Statutes. ~
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I was formerly a legal resident of --~~`~^~~~Ls'"~~"~-
(Ciy) (Stah)
and 1 resided at ~~!~1___i~ However 1 have chanqed my domic3le
(Sheet a Number)
to and am and have bean a bo~a fide resident of the State of Florida si~ce - day of
33~G~
- - - 19~, and 1 ~eside at _
(Straet and Number) •
FORT r1ERCE, SAINT LUCIE CCUNTY, RORI~A
and this statement is to be take~ as my declaration of citize~ship, act~al legal ~eside~ce and domicile in the State of Florida. -
(Inse~t here any peninent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
f~LEp AND RECORD~D
:T ROCER PO~ITRAS
u ~W"
CLEqK CtRCU1t C0~ ~
RECORD VERIFtEO~~
8 3 y~ PM'TI
2(,j31~~~ .
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1 RIRTHER ~ERTIFY that I will comply with all other requirements of a leqal resident of this State.
I FURTHER CERTIFY that I have no intention to retum to my former domicjle, and 1 intend to remain in FOR~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
Name)
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~ ca?~~~s~
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~;~~'~r~~1~fd`~)~'~y6suibed before me this ~ day of n-<< <t j , 19~.
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~ = ~i'• Notary Public
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By ` D.C. My Gommission expires
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"(T~ M~d M duplkaN ~ed eri~iaal Al~d wilh Cl~elc prwM Co~r1. ~ed dvplieat~ wilb Ta~c As~r.)
~ „ ~,QK 189 Pa~E 1210
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