HomeMy WebLinkAbout1372 o~claratlo~ ot oom1a11• a~d Clt~~nship 20~•~5.
,
TO THE STATE AND COUNTY TAX ASSESSOR.
Sl. lUC1E GOUNTY, FIORIDA:
This is my declaration of Domitile a~d Citizenship in ths State of Florida th~t 1~m filin~ this day i~ sooordanw and
in oonfo~mity with Chapter 222. Saction 222.17, Florida StatuMs.
I was formarly a leflal resident of
(City) (Stsh)
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and 1 rasided at 4 h~ ~ . Howevef I have chanyed my domid~e
(Street and Numbe~)
b and am and have been a bona fide resident of the Stste of Ftorida sinoe - dsy of
, 19 0, and 1 reside at ~ / v` v~`~ ~
- ~ (Street and Number)
fORT M~CE, SAINT LUCIE COUN?Y, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residenoe and domicile in the State of Florida.
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(Insert here any pertinent facts, such as sale of property or business, or relinquishment of amployment
at former domicile, mmoval of family to new domiale, purchase of home, etc.) ~
.!Z~<sYSZ t ~l'-~ ~
' F1lED ANO RECOROEO
ST. QOCER P~ITRAS ~
CLERK CI+~CUIT %
~T~~(
RECORO ~IER~FIEO ~.~'~"'~U ~
,~w 13 ~ g aT ~~'T1
203255
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I FURTHER CEitTIFY that I will oomply with all other rsquirsmenri of a te~al r~sident of this State.
1 FURTHER CERTIfY that I have no intention to return to my former domicG~e, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permane~tly.
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f~o6iq~ o~ ~ct e
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(Addres:)
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;.`~G'~~C~~;~~ksj~~subscribed before ms this day of , 19_~
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. N • ~ ~OURT~ Notary Public
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~ 8y~ ~ ~ v .C. My Commiuion expires
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Re b~ ~x~cvhd in dvplicsl~ snd ori~ieal Al~d wbb CIMIc Ckwif Covr1, awd d~plkaN wilh Tax Ai~~a
~ ~x189 ~~i~9
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