HomeMy WebLinkAbout1224 O~la~ation ot Oomicil• a~d Citis~nshlp
2(? 3~.:"~2
TO THE STATE AND COUNTY TAX ASSESSOR. .
Sl. IU~IE ~OUNTY, FLORIDA:
This is my declaratio~ of Oomicile and Citiz~nship in th~ Stat~ of Florida th~t 1 am filinq thit day in aooo~d~no~ e~d
~n oonformity with Chapter 222, Section 222.17, Florida Statutts. '
1 was formeriy a Isqal resident of Ew~v_~ ~ 1~'~W S ~1- -
(Cty) (St~t~)
l~ ~iQvbv s ,~i~t
and I resided at .~'T' -3 ~ ~ _ However 1 have chanqsd my domid~e
(Str~ef and Number)
b and am and hsve been a bona fide msident of the Staro of Florida sincs , ~7 ~ day of
_ , 19~Q, and 1 roside at 2 D 7 3 S~ , s~iP,~~ ~
~ (Street a~d Numbsr)
FORT l~iERCE, SAINT LUCIE COUNTY, RORIDA
a~d this statement is to be take~ as my detlaration of citizenship, attual leyal retidenoe and domidle in the State of Horida.
(Insert here any pertinent facts, suth as aale of property or business, or roiinquishment of employment
at fo~me~ domicile, removal of family ro new domicile, purchase of home, etc.)
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G~LLS~%K6~
f11E0 AMO RECQA~
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I FURTHER CHtTIFY that I will comply with all other rsquirements of a IeQal rssideM of this Stete.
I FURTHER CERTIFY thst I have no inteniion to retum to my former domicjfs, and 1 intend to remain in fORT
PIERCE, SAINT LUCIE COUNTY, FLORI~A, permanently.
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(Name)
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~ Sworn to and wbscribi~il~fd~" iiry~}~th~ / day of , 9~
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~ ROGER r01TRAS' ~ _ ~ O i _
~ C.LERK CIRC ~ _ ~ Notary Public
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By _ My Commiuion expires
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