HomeMy WebLinkAbout1242 Oaclaration ot Domicll~ +~~d Citls~nship
TO THE STATE AN~ COUNTY TAX ASSESSOR,
Sl. llJC1E COUNTY, FIORIDA:
This is my declaration of Domicile and CitiZenship in the State of Florida that 1 am f11in~ thi: day in aooo~danos and
in oonformity with Chapte? 222, Ssction 222.17, -Florida Statutes.
I was formerly a legal resident of ~u l~ F a R 1~ r _
(City) (Stah)
and 1 resided at • ~ Z _ Howevar 1 have chanqed my domidle
(Sheet and Number)
to and am and have been a bona fi~e resident of.the State of Florida si~ce `!Z day of
~t Gt~ s T , 19 ~d , and 1 ~eside at ~4 8 ~/?"i Ti4 ST.
(Street and Number)
PORT MERCE, SAINT LUCIE COUNTY, FLORIQA
and this statement is to be taken as my declaration of citizenship, attual legal residente and domicile in the Stste of Horida.
(Insert here any peNinent facis, such as sale of prope?ty or business, or relinquishment of employment
at former domicile, removal of family to new domitile, p~rchase of home, etc.) ~ ~
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s~WqE tOpM~fY ~LA.
AOCER P01~
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~ I FURTHER CERTIFY that I will oom with al) othar r uirem~nls of s I al r i
f ply eq sp es dent of this Ststs.
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~ I FURTHER CERTIFY that I have no intention to return to my former domiGle, snd I intend to remein in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ ~eip~t~+~f,~,.subscribsd before ms thi: / day of ~ , 19_~
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