HomeMy WebLinkAbout1382 D~ia~atio~ ot Don~lall~ a~d Citis~nship 2C:32~~~
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TO THE STATE AN~ ~OUNTY TAX ASSESSOR,
Sl. lUC1E ~OUNTY, FIORI~A:
This is my declaration of Oomicile and Citizenship in the State of Florida that 1 am filin~ thi: day in acoordano~ and
~n co~formity with Chapter 222, Section 222.17, Florida St~tutes.
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t was formerly a Isgal resident of ~ '1~
(~itY) (State)
and I resided at _ ~~C"'t . However 1 hsve chanyed my domivle
(Street and Numbe~)
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ro and am and have been a bona fide resident of tha State of Florida sinoe ~ day of
_ _ , 19 , and I teside at ` d~ ir
. (Street and Number)
FORT MERGE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actval legal residence a~d domiale in fhe Staro of Horida.
(Insert here any pe~tinent facts, such as sale of property or business, or relinquishment of employment
at former domitile, removal of family to new domicile, purchase of home, ett.) -
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~ fIlEO AtiO RECOIi0E9
ST.IUCIC COUNTr flA-
pOCER P4~TRAS
CIERK tIRCUlT COURt
RECORO YER~FIEO
i ,Uui t3 i0 ~8 ~M'1' 1
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4 1 FURTHER CERTIFY that I wi{I oomply with all .other rsquiremenri o~ a le~al resident of thi: State.
1 FURTHER CERTIfY that I have no intention to return to my former domicjle, end 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permane~tly. ~ Cs~i~ ~E/?T /~I ~PUE
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~ (Name)
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(Address)
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Swo~~ to and subsuibed before me thi: ,(~.L- day of , 19~.
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~ Notary Public
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~ Ely O.C. My Commiuion expires
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~ ' 4~0' 1~?• .~i1'.e~i~'plicai~ aed wi~inal Al~d whh Cl~elc Grarif Can1, and duplicai~ will~ Tax At»~x.)
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~ ~ FACt
c~ ~ 1379
~ ~ ~ ~o;K189
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