HomeMy WebLinkAbout1236 D~ciaratio~ ot Do~icil• and Cltl~~~ship
TO THE STATE ANO COUNTY TAX ASSESSOR. 203i~2 _
s~ . wciE cou~nr, FlOR10A:
This is my daclaratio~ of ~omicile and Citizenthip in tl?~ Stat~ of Florida that 1~m filirp thit d~y in aooo~d~noc and
in conformity wi~h Chapter 222. Section 22?.17. Florid~ Statutes.
I was fo~merly a leyel ~eaident _ ~ C -
(City) (Sta»)
and I ~esided at HowevK 1 h~ve ch~nq~d my domic3le
(Stnst and Numtier)
b and am end have been a bcna fide resident ~f the StaM of florida sinae _~~~~LQfc 9~ day of
~ ' ~s~,~~.r~,~ ~
, 191Q, and 1 reside at ~ c_r s~..~ • ~.c.~' •
. (Stnet and umbK)
FORT r1~CE, SAINT LUCIE COUNTY, RORlDA -
and this statement is to be taken as my decla~ation of citizenship, acfual laya! residence and domicile in the State of Horida.
(Insert here any peninent facts, such as sale of property or business, or ~elinquishment of employmsnt .
at former domicile, ~emoval of family ta new domicile, purchase of home, etc.)
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I FURTHER CERTIFY that I will oomply with all oMur raquirartwnri of a le~al resident of this Stat~.
- I FURTHER CERTIFY that 1 have no intention to retum to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
(Name)
~c ~i~ ` f ~S Q' J/ C~ s r~~
~ (A?ddress)
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:~~~a~~iihe} ~bed before me this day of a'K'i'~ 19~..
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6y D.C. My Gommission expires
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~Te , iM ~plka~a aad ~ioinal Al~i wilb CM~Ic Ciraril CouN, and d~plisaN wilb Tax A~~a
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