HomeMy WebLinkAbout1301 D~claratlo~ of Doml~til~ and Citisfnship ~
TO THE STATE AN~ COUNTY TAX ASSESSOR,
si . wciE couNnr, FlORIOA: ~03~~,
This is my decla~atio~ of Oomicile and Citiz~nship in th~ St~te of Flaida th~t 1 am fili~p this day in aooo~danc~ snd
~n conformity with Chapte~ 222, Ssctior~ 224.17, Horida Statutes.
1 was formerly a leqal resident of G
(Giy) tate)
and I ~esided at _~Y~3 ~C However 1 have d~n~ed my domidle
~ (Street and Number)
to and am a~d have been a bona fide ~ident of.the State of Florida sinoe day of
- - . 19_~, and I reside at . ~ ~l~`-~-
~ (Sheet snd Number)
FORT ~IERCE, SAINT LUCIE COUNTY, RORIDA
and this stateme~t is to be taken as my detlaration of citizenship, actusl legal residenoe and domicile in the State of Florida.
(Inse~t here a~y peninent facfs, such as sale of property or business, or ~elinquisfiment of employme~t
at former domicile, removel of family to new domicile, purchase of home, etc.)
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~ 1 FURTHER GERTIFY that 1 will comply with all other requirements of a Ispal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my forme~ domiCile, and I intend to remai~ in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanentiy_
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~ (Name) ~o G~.
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~ Sworn t4; a~d subscribed befo~e me this day of . , 19%.[
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' ~ ~ . ~ D.C. My Commiuion expires
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