HomeMy WebLinkAbout1227 O~claration ot ~nicll• a~d Citis~~shlp
TO THE STATE AN~ COUNTY TAX ASSESSOR. 20`3-~JJ
Sl. lUC1E ~OtJNTY. FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida th~t 1•m iili~q this day in aooordana and
in tonformity with Chapter 222, Sattior~ 222.17, Florids Statutes.
I was forme?ly a le~al resident of r " /C~
(Ciy) (Sta»)
and I resided at ~~L~~~/l L Hovwvsr I hav~ charpsd my domicjle
(Street and Number)
to a~d am a~d have been a bona fide resident of the Stsro of Florida sinos day of
, 19LO, and I ~eside at
(Streef and Number)
FORT N~CE, SAINT LUCIE COUNTY, RORIDA
and this statemsnt is to be taken as my declaration of citizen~ip, actual le9al retidenoe and domicile in the State of Horida.
(Insert he~e any pertinent facts, such as sale of property or business, or relinquiahment of empfoyment
at former domicile, removal of family to new domidle, purchase of home, etc.)
F0.E01?110 REC
iT. WCiE COIpITY~
~OCEIi PORRAt
CtER~ CIRCYiT C011~T
RECORO ~fEltIf1E0..~.,~L'L
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I FURTHER CERTIFY that I will oomply with all othsr requiremsnts of a le~al resident of this State.
I FURTHER CERTIFY that I have ~o intention to return to my former domicjle, snd 1 intend to ~emain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ (Name) l/
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~ `~t,;,5wa~4;~o ~nd wbsuibed before me this day of ~ ~ , 19~
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~ :~y ` • ` " ` O.C. My Gommiuion ~xpires
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~ rn• i. ~itLa~d in depWcM. .~wl e~tnal ni~d M?t~h u«Ic u.wit c~et, .nd d~ptk.~. wfli~ Tax A......~ra
~ ~ ~ 1~9 .
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