HomeMy WebLinkAbout1232 O~cla~atio~ of Domiall• and Citis~nship
TO THE STATE AN~ COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY. FlOR10A:
This is my declaretio~ of Oomicile and Citisenship in th~ Stat~ of Fiorida that 1 em filin~ thit day in aooordana and
in conformity with Chapter 222, Settio~ 22Z.17, H~~}¢~_Statutes.
, J~ Q
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I was formerly a legal resident of ~
iN) (Sta
and I ~esided at ~ " ~ . However 1 have charqsd my domic3le
(Street and Numbe~)
to a~d am and have baen a bona fide resident of the State of Florida sinoe / day of
~ , 19~~and 1 reside at ~1 ' ~
. (Street and Number)
FORT Pl~tCE, SAIN? LUCIE COUNTY, FLORIOA _
and this statemsnt is to be taken as my declaration of citize~ship, actual leflal re:idence and domicile in the Staro of Florida.
(Insert he~e any pertinent facts, sucfi as sale of property or busineu, or retinqvishment of emplayment
at fo~mer domicile, removal of family to new domicile, purchsse of home,_Qtc.)
~ f LED ANp RfCpRpE~
i~. ~1lClf COUMTY iLA.
RO~fR POITRAf
CIERK CIRCUIT CO{ill
RECORG YERIilEO
J~ ! I 10 ~1 ~H'T
'
~ . 2Q3158
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I RIRTHER CEitTIFY that l will oompty with all other requiremsnts of a le~al resic~ent of this Stats.
1 FURTHER CERTIFY that I have no intention to retum to my former domiCile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently.
'Lttf.Ll ' 'fi
- (Name) jjQ. I' r v~.
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(Acidres:)
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Sworn ~1p~•~~i ~;u ~ ~"~"~d before me this ~L / day of - ~ , 19~
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_ ;a~ ~ ' Notary Publk
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~ ~y • `r O.C. My Commission expires
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